Provider Demographics
NPI:1790156834
Name:SASICH, MARK (CADC I)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SASICH
Suffix:
Gender:M
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-2723
Mailing Address - Country:US
Mailing Address - Phone:541-883-2795
Mailing Address - Fax:541-504-1195
Practice Address - Street 1:340 NW 5TH ST
Practice Address - Street 2:BOX 1710
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1869
Practice Address - Country:US
Practice Address - Phone:541-883-2795
Practice Address - Fax:541-504-1195
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07-06-45101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)