Provider Demographics
NPI:1578007969
Name:CULTIVATING FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:CULTIVATING FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LICSW
Authorized Official - Phone:763-355-5461
Mailing Address - Street 1:3300 COUNTY ROAD 10 STE 304I
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3066
Mailing Address - Country:US
Mailing Address - Phone:763-355-5461
Mailing Address - Fax:763-355-5692
Practice Address - Street 1:3300 COUNTY ROAD 10
Practice Address - Street 2:SUITE 304I
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3072
Practice Address - Country:US
Practice Address - Phone:763-355-5461
Practice Address - Fax:763-355-5692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251861041C0700X
MN3003106H00000X
MN3003, 25186251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty