Basic Information
| Provider Information | |||||||||
| NPI: | 1639258866 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAGER | ||||||||
| FirstName: | MAX | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3506 VAN TEYLINGEN DR | ||||||||
| Address2: | APT C | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809174882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195700079 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2864 S CIRCLE DR | ||||||||
| Address2: | STE 600 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809064114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193144260 | ||||||||
| FaxNumber: | 7192646616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4109 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.