Provider Demographics
NPI:1245764927
Name:CULTIVATE TENNESSEE, LLC
Entity Type:Organization
Organization Name:CULTIVATE TENNESSEE, LLC
Other - Org Name:CULTIVATE BEHAVIORAL HEALTH AND EDUCATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:
Authorized Official - Last Name:CURLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-772-4042
Mailing Address - Street 1:12600 HILL COUNTRY BLVD STE R-100
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6748
Mailing Address - Country:US
Mailing Address - Phone:512-772-4042
Mailing Address - Fax:512-842-7446
Practice Address - Street 1:146 TIMBER CREEK DR STE 101
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4396
Practice Address - Country:US
Practice Address - Phone:901-249-7838
Practice Address - Fax:901-271-7180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CULTIVATE BEHAVIORAL MANAGEMENT CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-19
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ036970Medicaid