Organization Name: | SUN PRAIRIE PSYCHOLOGICAL SERVICES |
NPI Number: | 1306991682 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LAWRENCE JAMES STAVA (PARTNER) |
Mailing Address: | 705 W Main St Suite 3 Sun Prairie |
State: | WI US |
Postal Code: | 535902849 |
Phone Number: | 6088256663 |
Fax Number: | 6088256946 |
NPI Enumeration Date: | 01/24/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 1891 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |