| Sanctuary For Healing & Integration Pllc | |
|
860 E 4500 S Ste 302 Salt Lake City UT 84107-3018 | |
| (801) 268-0333 | |
| (801) 268-3777 |
| Full Name | Sanctuary For Healing & Integration Pllc |
|---|---|
| Speciality | Counselor |
| Location | 860 E 4500 S Ste 302, Salt Lake City, Utah |
| Authorized Official Name and Position | Carmela J Javellana (OWNER) |
| Authorized Official Contact | 8012680333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sanctuary For Healing & Integration Pllc 860 E 4500 S Ste 302 Salt Lake City UT 84107-3018 Ph: (801) 268-0333 | Sanctuary For Healing & Integration Pllc 860 E 4500 S Ste 302 Salt Lake City UT 84107-3018 Ph: (801) 268-0333 |
| NPI Number | 1417218371 |
|---|---|
| Provider Enumeration Date | 06/06/2012 |
| Last Update Date | 06/06/2012 |
| Medicare PECOS PAC ID | 4385882588 |
|---|---|
| Medicare Enrollment ID | O20130529000943 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417218371 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 280094-1205 (Utah) | Primary |
| Provider Name | Carmela J Javellana |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215031778 PECOS PAC ID: 9436130887 Enrollment ID: I20040601000404 |
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