Provider Demographics
NPI:1174198345
Name:CULTIVATE HOPE KC
Entity Type:Organization
Organization Name:CULTIVATE HOPE KC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTAMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:913-318-4679
Mailing Address - Street 1:11900 COLLEGE BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-4048
Mailing Address - Country:US
Mailing Address - Phone:913-318-4679
Mailing Address - Fax:
Practice Address - Street 1:405 S CLAIRBORNE RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1795
Practice Address - Country:US
Practice Address - Phone:913-318-4679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty