Organization
CULTIVATING LIFE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARISSA CHISM BUGGS MD (MEDICAL DIRECTOR)
(574) 444-0256
Entity
Organization
Contact information
Practice address
3607 S MAIN ST, SOUTH BEND, IN 46614-1723
(574) 444-0256
Mailing address
3607 S MAIN ST STE 1, SOUTH BEND, IN 46614-1723
(574) 444-0256
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Enumeration date
01/18/2025
Last updated
01/18/2025
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