| NPI | 1205108826 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY MAX Clinical Psychologist 847-275-5589 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.005848) |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2012-01-27 |