Healthcare Provider Details

I. General information

NPI: 1053226233
Provider Name (Legal Business Name): SANCTUARY THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10546 W. OAKMONT DRIVE
SUN CITY AZ
85351
US

IV. Provider business mailing address

8877 N 107TH AVE STE 302
PEORIA AZ
85345-7474
US

V. Phone/Fax

Practice location:
  • Phone: 623-738-5079
  • Fax:
Mailing address:
  • Phone: 623-738-5079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JODY D MOORE
Title or Position: OWNER
Credential: LPC
Phone: 623-738-5079