Provider Demographics
NPI:1821048067
Name:ELLIE ZACKS, PHD CLINICAL PSYCHOLOGIST, APC
Entity Type:Organization
Organization Name:ELLIE ZACKS, PHD CLINICAL PSYCHOLOGIST, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-863-1790
Mailing Address - Street 1:9700 FAIR OAKS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7079
Mailing Address - Country:US
Mailing Address - Phone:916-863-1790
Mailing Address - Fax:
Practice Address - Street 1:9700 FAIR OAKS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7079
Practice Address - Country:US
Practice Address - Phone:916-863-1790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10426103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty