=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386517308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANCTUARY SESSIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2025
-----------------------------------------------------
Last Update Date | 09/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 TEXAS ST STE 950
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71101-3538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-214-7455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 SPORTSMAN LODGE RD
-----------------------------------------------------
City | CAMPTI
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71411-4535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-214-7455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RUBY JOHNSON
-----------------------------------------------------
Credential | MA, LPC
-----------------------------------------------------
Telephone | 318-214-7455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------