MEDICARE: SOUL SANCTUARY HEALING AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1821677527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL SANCTUARY HEALING AND WELLNESS

Provider Business Mailing Address
First Line	:	2400 SPENARD RD STE 200
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-1644
Country	:	US
Telephone Number	:	855-573-4980
Fax Number	:	833-990-0956

Provider Business Practice Location Address
First Line	:	2400 SPENARD RD STE 200
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-1644
Country	:	US
Telephone Number	:	855-573-4980
Fax Number	:	833-990-0956

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	JEANNE BRADY
Credential	:	PSYD
Telephone Number	:	855-573-4980

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	03/15/2025

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