NPIMap

Organization Active NPI

Sun Prairie Psychological Services

  • Clinical Psychologist
  • Sun Prairie, WI
National Provider Identifier
1306991682
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1891 Issued in WI
Legal business name
SUN PRAIRIE PSYCHOLOGICAL SERVICES
Practice address
705 W Main St
Suite 3
Sun Prairie, WI 53590-2849
Phone
(608) 825-6663
Fax
(608) 825-6946
NPI assigned
Jan 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Lawrence James Stava, PH.D.NPI 1215028311
Title
Partner
Phone
(608) 825-6663

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 1891 WI Primary

Addresses

Primary practice location

705 W Main St
Suite 3
Sun Prairie, WI 53590-2849

Mailing address

705 W Main St
Suite 3
Sun Prairie, WI 53590-2849
Phone (608) 825-6663

Other identifiers 1

IdentifierTypeStateIssuer
42168100MedicaidWI

National Provider Directory

National Provider Directory

Locations

705 W Main St
Ste 3
Sun Prairie, WI 53590
Phone (608) 825-6663

705 W Main St
Sun Prairie, WI 53590
Phone (608) 825-6663

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306991682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 W MAIN ST",
            "address_2": "SUITE 3",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535902849",
            "telephone_number": "608-825-6663",
            "fax_number": "608-825-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 W MAIN ST",
            "address_2": "SUITE 3",
            "city": "SUN PRAIRIE",
            "state": "WI",
            "postal_code": "535902849",
            "telephone_number": "608-825-6663",
            "fax_number": "608-825-6946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN PRAIRIE PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STAVA",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "608-825-6663",
        "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": "1891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42168100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sun Prairie, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.