Provider Demographics
NPI:1811347982
Name:ENDSLEY, MAURICE JR (PHD)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:
Last Name:ENDSLEY
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1858 W HURON ST
Mailing Address - Street 2:APT 2F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5526
Mailing Address - Country:US
Mailing Address - Phone:314-479-7596
Mailing Address - Fax:
Practice Address - Street 1:1858 W HURON ST
Practice Address - Street 2:APT 2F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5526
Practice Address - Country:US
Practice Address - Phone:314-479-7596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist