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General NPI Number Information
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NPI Number | 1578007969
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Entity Type | Organization
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Legal Business Name | CULTIVATING FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 3300 COUNTY ROAD 10 SUITE 304I
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-3072
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Country | US
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Telephone | 763-355-5461
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Fax | 763-355-5692
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Provider Business Mailing Address
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Address Line | 3300 COUNTY ROAD 10 STE 304I
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-3066
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Country | US
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Telephone | 763-355-5461
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Fax | 763-355-5692
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Authorized Official
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Title or Position | DIRECTOR
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Name | KESHA GREEN
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Credential | LMFT, LICSW
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Telephone | 763-355-5461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3003
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3003, 25186
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 25186
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License Number State | MN
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