| Sanctuary Psychotherapy Services Llc | |
|
5737 S Watterson Trl Apt 5 Louisville KY 40291-1899 | |
| (452) 744-4708 | |
| (502) 331-6062 |
| Full Name | Sanctuary Psychotherapy Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5737 S Watterson Trl Apt 5, Louisville, Kentucky |
| Authorized Official Name and Position | Maria Wibbels (OWNER) |
| Authorized Official Contact | 8452744470 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sanctuary Psychotherapy Services Llc 5737 S Watterson Trl Apt 5 Louisville KY 40291-1899 Ph: (845) 274-4470 | Sanctuary Psychotherapy Services Llc 5737 S Watterson Trl Apt 5 Louisville KY 40291-1899 Ph: (452) 744-4708 |
| NPI Number | 1104563378 |
|---|---|
| Provider Enumeration Date | 05/18/2022 |
| Last Update Date | 05/18/2022 |
| Certification Date | 05/18/2022 |
| Medicare PECOS PAC ID | 1355729856 |
|---|---|
| Medicare Enrollment ID | O20220610001490 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104563378 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Maria Wibbels |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114014636 PECOS PAC ID: 4981891124 Enrollment ID: I20201118003189 |
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