Provider Demographics
NPI:1104698307
Name:CULTIVATING CHOICES PLLC
Entity type:Organization
Organization Name:CULTIVATING CHOICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC CLINICAL DIRECTOR AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:331-305-4055
Mailing Address - Street 1:444 E ROOSEVELT RD STE 252
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4630
Mailing Address - Country:US
Mailing Address - Phone:331-305-4055
Mailing Address - Fax:
Practice Address - Street 1:1611 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:331-305-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty