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General NPI Number Information
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NPI Number | 1235792599
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Entity Type | Organization
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Legal Business Name | SACRED HOLISTIC PATH SANCTUARY REFUGE INCORPORATED
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 07/03/2019
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Provider Practice Location Address
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Address Line | 15360 FM 850
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City | TYLER
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State | TX
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Zip | 75707-3916
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Country | US
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Telephone | 936-645-9939
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Fax | 903-253-0466
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Provider Business Mailing Address
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Address Line | P.O. BOX 9636
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City | TYLER
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State | TX
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Zip | 75711
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Country | US
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Telephone | 936-645-9939
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOBERT STANLEY MILLER
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Credential | LMSW
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Telephone | 903-732-6271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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