NPIMap

Organization Active NPI

Clinical Psychology Associates, LLC

Doing business as Clinical Psychology Associates

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Burlington, WI
National Provider Identifier
1619156502
Registry record updated Apr 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CLINICAL PSYCHOLOGY ASSOCIATES, LLC
Doing business as
Clinical Psychology Associates
Practice address
197 W Chestnut St Ste 100
Burlington, WI 53105-1200
Phone
(262) 763-9191
Fax
(262) 763-7767
NPI assigned
Oct 29, 2007
Last updated
Apr 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2021

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

Authorized official

Name
Dr. David William Thompson, PHDNPI 1508896606
Title
Clinic Director/Owner
Phone
(262) 763-9191

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Psychologist 103T00000X NU
Clinical Psychologist 103TC0700X 1588 WI

Addresses

Primary practice location

197 W Chestnut St Ste 100
Burlington, WI 53105-1200

Mailing address

197 W Chestnut St Ste 100
Burlington, WI 53105-1200
Phone (262) 763-9191

Other identifiers 1

IdentifierTypeStateIssuer
42171100MedicaidWI

Other names 1

  • Clinical Psychology Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210329001981 WI Part B Supplier - Clinic/Group Practice 4284041740 Receives reassigned benefits from 4 practitioners
Practice locations: Burlington, WI

National Provider Directory

National Provider Directory

Locations

345 Milwaukee Ave
Burlington, WI 53105
Phone (262) 763-9191

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619049600000",
    "number": "1619156502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "197 W CHESTNUT ST STE 100",
            "city": "BURLINGTON",
            "state": "WI",
            "postal_code": "531051200",
            "telephone_number": "262-763-9191",
            "fax_number": "262-763-7767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "197 W CHESTNUT ST STE 100",
            "city": "BURLINGTON",
            "state": "WI",
            "postal_code": "531051200",
            "telephone_number": "262-763-9191",
            "fax_number": "262-763-7767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL PSYCHOLOGY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-29",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "CLINIC DIRECTOR/OWNER",
        "authorized_official_telephone_number": "262-763-9191",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "1588",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42171100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinical Psychology Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinical Psychology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burlington, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.