Provider Demographics
NPI:1104592450
Name:CULTIVATING HOPE COLLABORATIVE THERAPY, PLC
Entity type:Organization
Organization Name:CULTIVATING HOPE COLLABORATIVE THERAPY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIMITED LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:419-205-3801
Mailing Address - Street 1:25600 WOODWARD AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0944
Mailing Address - Country:US
Mailing Address - Phone:734-926-9337
Mailing Address - Fax:734-423-1419
Practice Address - Street 1:25600 WOODWARD AVE STE 109
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0944
Practice Address - Country:US
Practice Address - Phone:734-926-9337
Practice Address - Fax:734-423-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376850867OtherLARA