Provider Demographics
NPI:1124273743
Name:MAXWELL, CLINTON BROCK (MA, LMHC)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:BROCK
Last Name:MAXWELL
Suffix:
Gender:
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8248 KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2717
Mailing Address - Country:US
Mailing Address - Phone:224-254-3726
Mailing Address - Fax:
Practice Address - Street 1:8248 KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2717
Practice Address - Country:US
Practice Address - Phone:224-254-3726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health