Individual provider Active NPI

Bret Stalcup, LMFT, MS

  • Marriage & Family Therapist
  • Fitchburg, WI
National Provider Identifier
1962078188
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
756-228 Issued in WI
Practice address
2960 Triverton Pike Dr
Fitchburg, WI 53711-5896
Phone
(608) 400-3818
NPI assigned
May 28, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 756-228 WI Primary

Addresses

Primary practice location

2960 Triverton Pike Dr
Fitchburg, WI 53711-5896

Mailing address

2960 Triverton Pike Dr
Fitchburg, WI 53711-5896
Phone (608) 400-3818

Other practice location 1

840 State Road 136 Ste 1
Baraboo, WI 53913-9252
Phone (608) 477-9858

Other practice location 2

6720 Stonefield Road
Ste 101
Middleton, WI 53562
Phone (608) 400-3818

Other identifiers 1

IdentifierTypeStateIssuer
100170870MedicaidWI

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
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
756-228WIMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Innervisions Counseling & Consulting Center, S.C. CurrentSince Jun 1, 2021 Accepting new patients
Northern Roots Therapy Center CurrentSince Sep 29, 2024 Accepting new patients

Locations

840 State Road 136
Ste 1
Baraboo, WI 53913
Phone (608) 477-9858

2960 Triverton Pike Dr
Fitchburg, WI 53711
Phone (608) 234-1224

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1622160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1962078188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2960 TRIVERTON PIKE DR",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "537115896",
            "telephone_number": "608-400-3818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2960 TRIVERTON PIKE DR",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "537115896",
            "telephone_number": "608-400-3818"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "840 State Road 136 Ste 1",
            "address_purpose": "LOCATION",
            "city": "Baraboo",
            "state": "WI",
            "postal_code": "539139252",
            "country_code": "US",
            "telephone_number": "608-477-9858",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6720 Stonefield Road",
            "address_2": "Ste 101",
            "address_purpose": "LOCATION",
            "city": "Middleton",
            "state": "WI",
            "postal_code": "53562",
            "country_code": "US",
            "telephone_number": "608-400-3818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STALCUP",
        "first_name": "BRET",
        "credential": "LMFT, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-28",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "756-228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100170870",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fitchburg, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; 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.