=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922825371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CULTIVATING CONNECTIONS THERAPEUTIC & CONSULTING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2024
-----------------------------------------------------
Last Update Date | 11/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 274 OLD CORVALLIS RD STE W
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59840-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-409-6058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 61
-----------------------------------------------------
City | CORVALLIS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59828-0061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-409-6058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHEREESE L JENNINGS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 406-409-6058
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------