=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366230476
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CULTIVATING MINDS BEHAVIORAL HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2025
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 TELEPORT BLVD UNIT 140189
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75014-0027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-290-1095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3900 TELEPORT BLVD UNIT 140189
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75014-0027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-CEO
-----------------------------------------------------
Name | MELANIE L LEWIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 985-290-1095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------