Provider Demographics
NPI:1356460984
Name:STEBBINS, GLENN THRUSTON III (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:THRUSTON
Last Name:STEBBINS
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-563-3854
Mailing Address - Fax:312-563-4009
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 309
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-563-3854
Practice Address - Fax:312-563-4009
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical