Provider Demographics
NPI:1104681402
Name:CULTIVATING CONNECTION INCORPORATED
Entity type:Organization
Organization Name:CULTIVATING CONNECTION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PEYTON
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:541-517-6138
Mailing Address - Street 1:1315 FRANKLIN ST APT A
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2630
Mailing Address - Country:US
Mailing Address - Phone:541-517-6138
Mailing Address - Fax:
Practice Address - Street 1:1315 FRANKLIN ST APT A
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2630
Practice Address - Country:US
Practice Address - Phone:541-517-6138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty