Provider Demographics
NPI:1386835551
Name:SACHS, SHELLEY STEWART (MFT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:STEWART
Last Name:SACHS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 E WELL WOOD RD APT 28P
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4069
Mailing Address - Country:US
Mailing Address - Phone:858-248-0671
Mailing Address - Fax:
Practice Address - Street 1:8184 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6477
Practice Address - Country:US
Practice Address - Phone:801-944-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 46165106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist