Healthcare Provider Details

I. General information

NPI: 1881598332
Provider Name (Legal Business Name): SANCTUARY BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 N PARK DR STE 103
WESTON FL
33326-3226
US

IV. Provider business mailing address

420 NW 30TH TER
FORT LAUDERDALE FL
33311-8436
US

V. Phone/Fax

Practice location:
  • Phone: 786-565-2233
  • Fax:
Mailing address:
  • Phone: 954-683-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. TELMA RODRIGUEZ
Title or Position: LMHC
Credential:
Phone: 954-683-9940