Organization
SACRED HOLISTIC PATH SANCTUARY REFUGE INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOBERT STANLEY MILLER LMSW (PRESIDENT)
(903) 732-6271
Entity
Organization
Contact information
Practice address
15360 FM 850, TYLER, TX 75707-3916
(936) 645-9939
(903) 253-0466
Mailing address
P.O. BOX 9636, TYLER, TX 75711
(936) 645-9939
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
251V00000X
Voluntary or Charitable Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17799986
PRIVATE INSURANCE
TX
Enumeration date
04/22/2019
Last updated
07/03/2019
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