NPIMap

Organization Active NPI

Sanctuary Psychotherapy Services LLC

  • Clinical Social Worker
  • Louisville, KY
National Provider Identifier
1104563378
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SANCTUARY PSYCHOTHERAPY SERVICES LLC
Practice address
5737 S Watterson TRL Apt 5
Louisville, KY 40291-1899
Phone
(452) 744-4708
Fax
(502) 331-6062
NPI assigned
May 18, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Maria Wibbels, LCSW
Title
Owner
Phone
(845) 274-4470

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

5737 S Watterson TRL Apt 5
Louisville, KY 40291-1899

Mailing address

5737 S Watterson TRL Apt 5
Louisville, KY 40291-1899
Phone (845) 274-4470

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652832000000",
    "number": "1104563378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5737 S WATTERSON TRL APT 5",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402911899",
            "telephone_number": "845-274-4470",
            "fax_number": "502-331-6062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5737 S WATTERSON TRL APT 5",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402911899",
            "telephone_number": "452-744-4708",
            "fax_number": "502-331-6062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANCTUARY PSYCHOTHERAPY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-18",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A",
        "authorized_official_last_name": "WIBBELS",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-274-4470",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.