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General NPI Number Information
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NPI Number | 1205108826
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Entity Type | Organization
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Legal Business Name | STACEY MAX, PSY.D.
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 250 PARKWAY DR SUITE 150
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069-4322
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Country | US
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Telephone | 847-275-5589
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Fax |
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Provider Business Mailing Address
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Address Line | 250 PARKWAY DR SUITE 150
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069-4322
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Country | US
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Telephone | 847-275-5589
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. STACEY MAX
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Credential | PSY.D.
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Telephone | 847-275-5589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.005848
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License Number State | IL
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