Organization
CULTIVATE COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CHAD WILSON LCSW (OWNER/ADMINISTRATOR)
(208) 724-0913
Entity
Organization
Contact information
Practice address
3023 E COPPER POINT DR STE 108, MERIDIAN, ID 83642-9290
(208) 914-8924
Mailing address
10421 W BROWNSTONE DR, BOISE, ID 83709-5612
(208) 724-0913
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
08/26/2021
Last updated
08/26/2021
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