Provider Demographics
NPI:1457762601
Name:HORBACK, SACHI
Entity Type:Individual
Prefix:
First Name:SACHI
Middle Name:
Last Name:HORBACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4843 JOHNSON POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-9152
Mailing Address - Country:US
Mailing Address - Phone:610-574-6192
Mailing Address - Fax:
Practice Address - Street 1:677 WOODLAND SQUARE LOOP SE
Practice Address - Street 2:B6
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1000
Practice Address - Country:US
Practice Address - Phone:610-574-6192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60414011103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical