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General NPI Number Information
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NPI Number | 1154956761
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Entity Type | Organization
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Legal Business Name | THE SANCTUARY SERVICES, LLC
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Dates
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Enumeration Date | 03/04/2020
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 921 4TH AVE
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City | WORTHINGTON
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State | MN
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Zip | 56187-2372
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Country | US
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Telephone | 605-961-8156
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Fax |
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Provider Business Mailing Address
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Address Line | 10916 US HIGHWAY 59
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City | FULDA
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State | MN
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Zip | 56131-1325
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Country | US
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Telephone | 605-961-8156
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Fax |
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Authorized Official
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Title or Position | LICENSED MARRIAGE & FAMILY THERAPIS
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Name | ANDREA L BLOCH
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Credential | LMFT
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Telephone | 605-961-8156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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