Organization Name: | STACEY MAX, PSY.D. |
NPI Number: | 1205108826 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STACEY MAX (CLINICAL PSYCHOLOGIST) |
Mailing Address: | 250 Parkway Dr Suite 150 Lincolnshire |
State: | IL US |
Postal Code: | 600694322 |
Phone Number: | 8472755589 |
Fax Number: | |
NPI Enumeration Date: | 01/27/2012 |
NPI Last Update Date: | 01/27/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 071.005848 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |