# CULTIVATING LIFE CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982415873
- **Authorized official:** LARISSA CHISM BUGGS MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (574) 444-0256

## Contact information

- **Practice address:** 3607 S MAIN ST, SOUTH BEND, IN 46614-1723
- **Practice address phone:** (574) 444-0256
- **Mailing address:** 3607 S MAIN ST STE 1, SOUTH BEND, IN 46614-1723
- **Mailing address phone:** (574) 444-0256

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/18/2025
- **Last updated:** 01/18/2025