Provider Demographics
NPI:1023691490
Name:CULTIVATE MENTAL HEALTH PC
Entity type:Organization
Organization Name:CULTIVATE MENTAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MBA CNM PMHNP-BC
Authorized Official - Phone:303-918-9828
Mailing Address - Street 1:11164 CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3918
Mailing Address - Country:US
Mailing Address - Phone:303-918-9828
Mailing Address - Fax:303-529-3167
Practice Address - Street 1:11164 CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3918
Practice Address - Country:US
Practice Address - Phone:303-918-9828
Practice Address - Fax:303-529-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty