Active NPI
Sage Bradley Shaw, LMLP
- Psychologist
- Ottawa, KS
National Provider Identifier
1801554779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LMLP03376
- Practice address
- 109 W 2ND St Ste a
Ottawa, KS 66067-2212 - Phone
- (785) 242-2991
- Fax
- (785) 242-4401
- NPI assigned
- Dec 7, 2021
- Last updated
- Mar 9, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LMLP03376 | KS | Primary |
Addresses
Primary practice location
109 W 2ND St Ste a
Ottawa, KS 66067-2212
Mailing address
1953 Reno Rd
Ottawa, KS 66067-8754
Phone (785) 214-9338
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMLP03376 | KS | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741478400000",
"number": "1801554779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1953 RENO RD",
"city": "OTTAWA",
"state": "KS",
"postal_code": "660678754",
"telephone_number": "785-214-9338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 W 2ND ST STE A",
"city": "OTTAWA",
"state": "KS",
"postal_code": "660672212",
"telephone_number": "785-242-2991",
"fax_number": "785-242-4401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "SAGE",
"middle_name": "BRADLEY",
"credential": "LMLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-12-07",
"last_updated": "2025-03-09",
"certification_date": "2025-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "KS",
"license": "LMLP03376",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ottawa, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.