Active NPI
Shannon M Sticken, PSY.D.
- Clinical Psychologist
- Tucson, AZ
National Provider Identifier
1417281296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4233
- Practice address
- 1661 N Swan Rd Ste 200-3
Tucson, AZ 85712-4042 - Phone
- (520) 326-5761
- NPI assigned
- Sep 25, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Clinical Psychologist | 103TC0700X | 4233 | AZ | Primary |
Addresses
Primary practice location
1661 N Swan Rd Ste 200-3
Tucson, AZ 85712-4042
Mailing address
1661 N Swan Rd Ste 200-3
Tucson, AZ 85712-4042
Phone (520) 326-5761
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 13, 2023 through Feb 13, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676332800000",
"number": "1417281296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1661 N SWAN RD STE 200-3",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857124042",
"telephone_number": "520-326-5761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1661 N SWAN RD STE 200-3",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857124042",
"telephone_number": "520-326-5761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STICKEN",
"first_name": "SHANNON",
"middle_name": "M",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-25",
"last_updated": "2023-02-14",
"certification_date": "2023-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AZ",
"license": "4233",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.