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General NPI Number Information
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NPI Number | 1932099389
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Entity Type | Organization
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Legal Business Name | SANCTUM PSYCHOTHERAPY
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 5201 EDEN AVE STE 322
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City | EDINA
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State | MN
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Zip | 55436-2316
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Country | US
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Telephone | 612-314-9077
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Fax |
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Provider Business Mailing Address
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Address Line | 5201 EDEN AVE STE 322
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City | EDINA
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State | MN
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Zip | 55436-2316
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Country | US
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Telephone | 612-314-9077
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. WARREN ALLEN TAYLOR
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Credential | MA/PHD (C)
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Telephone | 612-314-9077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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