Provider Demographics
NPI:1164252128
Name:SACKS, LIAM B (LMFT)
Entity type:Individual
Prefix:
First Name:LIAM
Middle Name:B
Last Name:SACKS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4169 VIA MARINA APT 415
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5334
Mailing Address - Country:US
Mailing Address - Phone:571-251-4061
Mailing Address - Fax:
Practice Address - Street 1:4169 VIA MARINA APT 415
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5334
Practice Address - Country:US
Practice Address - Phone:571-251-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist