Provider Demographics
NPI:1639258866
Name:STAGER, MAX A (LPC)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:A
Last Name:STAGER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 S 8TH ST # 38145
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1933
Mailing Address - Country:US
Mailing Address - Phone:719-460-4185
Mailing Address - Fax:719-900-1838
Practice Address - Street 1:1540 S 8TH ST # 38145
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1933
Practice Address - Country:US
Practice Address - Phone:719-460-4185
Practice Address - Fax:719-900-1838
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional