Provider Demographics
NPI:1154987410
Name:STACY PAPANGELIS, MA, PLLC
Entity type:Organization
Organization Name:STACY PAPANGELIS, MA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPANGELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:312-206-7466
Mailing Address - Street 1:3600 N. LAKE SHORE DRIVE
Mailing Address - Street 2:2615
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4679
Mailing Address - Country:US
Mailing Address - Phone:312-206-7466
Mailing Address - Fax:
Practice Address - Street 1:3600 N. LAKE SHORE DRIVE
Practice Address - Street 2:2615
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4679
Practice Address - Country:US
Practice Address - Phone:312-206-7466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STACY PAPANGELIS, MA, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-13
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)