| Organization Name: | FRED M. SACKS, PH.D. & ASSOCIATES |
| NPI Number: | 1295088078 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FRED M SACKS (OWNER / PSYCHOLOGIST) |
| Mailing Address: | 1485 Commerce Park Dr Tipp City |
| State: | OH US |
| Postal Code: | 453712883 |
| Phone Number: | 9376675126 |
| Fax Number: | 9376677583 |
| NPI Enumeration Date: | 10/18/2012 |
| NPI Last Update Date: | 10/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 3768 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |