Provider Demographics
NPI:1831421130
Name:SACKETT, LISA M (MFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:SACKETT
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 1:7577 CENTRAL PARKE BLVD
Mailing Address - Street 2:SUITE 326
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6810
Mailing Address - Country:US
Mailing Address - Phone:513-770-3231
Mailing Address - Fax:513-770-5541
Practice Address - Street 1:7577 CENTRAL PARKE BLVD
Practice Address - Street 2:SUITE 326
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6810
Practice Address - Country:US
Practice Address - Phone:513-770-3231
Practice Address - Fax:513-770-5541
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0800004106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist