Provider Demographics
NPI:1194571711
Name:CULTIVATION LIBERATION FAMILY COUNSELING AND PSYCHOTHERAPY INC.
Entity type:Organization
Organization Name:CULTIVATION LIBERATION FAMILY COUNSELING AND PSYCHOTHERAPY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:707-666-5170
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95473-0910
Mailing Address - Country:US
Mailing Address - Phone:707-666-5170
Mailing Address - Fax:
Practice Address - Street 1:7808 STEFENONI CT UNIT B
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3535
Practice Address - Country:US
Practice Address - Phone:707-666-5170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty