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General NPI Number Information
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NPI Number | 1427965300
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Entity Type | Organization
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Legal Business Name | SACRED SPACE THERAPY LLC
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Dates
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Enumeration Date | 08/26/2026
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Last Update Date | 08/26/2026
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Provider Practice Location Address
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Address Line | 125 OAK ST
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City | REVERE
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State | MN
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Zip | 56166-4000
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Country | US
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Telephone | 763-213-3933
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Fax | 320-233-4071
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Provider Business Mailing Address
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Address Line | 125 OAK ST
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City | REVERE
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State | MN
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Zip | 56166-4000
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Country | US
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Telephone | 763-213-3933
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Fax | 320-233-4071
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Authorized Official
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Title or Position | OWNER, PSYCHOTHERAPIST
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Name | MS. TANYA ANNE LAMBERT
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Credential | LPCC
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Telephone | 763-213-3933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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