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General NPI Number Information
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NPI Number | 1275199804
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Entity Type | Organization
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Legal Business Name | CULTIVATING WELLNESS
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 227 E SUNSHINE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65807-2652
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Country | US
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Telephone | 417-709-4909
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Fax | 417-709-4909
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Provider Business Mailing Address
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Address Line | 227 E SUNSHINE ST STE 112
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City | SPRINGFIELD
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State | MO
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Zip | 65807-2630
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Country | US
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Telephone | 417-709-4909
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ANGELA K COULTER
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Credential | LCSW
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Telephone | 417-766-5566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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