Provider Demographics
NPI:1548567241
Name:SACKS CLINICAL CONSULTING, PC
Entity Type:Organization
Organization Name:SACKS CLINICAL CONSULTING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SACKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:219-210-0111
Mailing Address - Street 1:107 WOODLAND CT
Mailing Address - Street 2:STE B
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7392
Mailing Address - Country:US
Mailing Address - Phone:219-628-6463
Mailing Address - Fax:219-809-0200
Practice Address - Street 1:107 WOODLAND CT
Practice Address - Street 2:STE B
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7392
Practice Address - Country:US
Practice Address - Phone:219-628-6463
Practice Address - Fax:219-809-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041854A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty