Elkhart Psychological Services, LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1610 Issued in WI

Legal business name

ELKHART PSYCHOLOGICAL SERVICES, LLC

Practice address

6000 Monona Dr
Suite 203
Monona, WI 53716-3931

Phone

(608) 223-9767

Fax

(608) 223-9767

NPI assigned

Apr 6, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lawrence Mandt, PH.D

Title

Owner

Phone

(608) 223-9767

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Catherine Enos Mandt, M.S., M.A.

  • Professional Counselor
  • Monona, WI
  • NPI 1407175250
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1265554430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 MONONA DR",
            "address_2": "SUITE 203",
            "city": "MONONA",
            "state": "WI",
            "postal_code": "537163931",
            "telephone_number": "608-223-9767",
            "fax_number": "608-223-9767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 MONONA DR",
            "address_2": "SUITE 203",
            "city": "MONONA",
            "state": "WI",
            "postal_code": "537163931",
            "telephone_number": "608-223-9767",
            "fax_number": "608-223-9767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELKHART PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "MANDT",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-223-9767",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "1610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS PLUS",
            "identifier": "1011078",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39088600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Monona, WI
• Providers in Monona, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.