Provider Demographics
NPI:1417218371
Name:SANCTUARY FOR HEALING & INTEGRATION PLLC
Entity Type:Organization
Organization Name:SANCTUARY FOR HEALING & INTEGRATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JAVELLANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-268-0333
Mailing Address - Street 1:860 E 4500 S STE 302
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3018
Mailing Address - Country:US
Mailing Address - Phone:801-268-0333
Mailing Address - Fax:801-268-3777
Practice Address - Street 1:860 E 4500 S STE 302
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3018
Practice Address - Country:US
Practice Address - Phone:801-268-0333
Practice Address - Fax:801-268-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT280094-1205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012280Medicare UPIN