Provider Demographics
NPI:1033601026
Name:CULTIVATE COUNSELING, LLC
Entity Type:Organization
Organization Name:CULTIVATE COUNSELING, LLC
Other - Org Name:CULTIVATE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:717-446-8332
Mailing Address - Street 1:1915 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17202-3351
Mailing Address - Country:US
Mailing Address - Phone:717-446-8332
Mailing Address - Fax:717-496-0170
Practice Address - Street 1:1915 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202-3351
Practice Address - Country:US
Practice Address - Phone:717-446-8332
Practice Address - Fax:717-496-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102592164001Medicaid