STACY L SULLIVAN (NPI# 1457876062) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457876062 |
| Entity Type | Individual |
| Full Name | STACY L SULLIVAN |
| Credential | LPC |
| Practice Address |
6502 Grand Teton Plz Ste 204 Madison WI 53719-1047 |
| Mailing Address |
3602 Sunbrook Rd Madison WI 53704-2733 |
| Practice Telephone | 6083381786 |
| Practice Fax Number | 6088314383 |
| Mailing Telephone | 6086069733 |
| Enumeration Date | 2017-08-04 |
| Last Update Date | 2017-08-04 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
5783-125 | WI | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497065213 | Stacy Sullivan | Speech-Language Pathologist | 235 Jackson Crescent, Centerport, NY 11721 | 2010-10-14 |
| 1598019325 | Stacy Lynn Sullivan | Dentist | 36600 Heritage Dr, Richmond, MI 48062-1937 | 2012-10-31 |
| 1306987631 | Stacy Anne Sullivan | Dentist | 217 E Willow St, Yadkinville, NC 27055-8193 | 2007-02-09 |
| Street Address |
6502 GRAND TETON PLZ STE 204 |
| City | MADISON |
| State | WI |
| Zip Code | 53719-1047 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750780193 | Peace of Mind Therapy | Marriage & Family Therapist | 6502 Grand Teton Plz Ste 204, Madison, WI 53719-1047 | 2014-08-21 |
| 1962992560 | Kellie S Murphy | Counselor | 6502 Grand Teton Plz Ste 204, Madison, WI 53719 | 2018-05-18 |
| 1417475237 | Ashleigh Rae Neesam-abushhiwa | Counselor | 6502 Grand Teton Plz Ste 204, Madison, WI 53719-1047 | 2017-08-31 |
| 1306396767 | Katherine Ann Premo | Marriage & Family Therapist | 6502 Grand Teton Plz Ste 204, Madison, WI 53719-1047 | 2016-10-10 |
| 1023406691 | Lisa D. Yee | Marriage & Family Therapist | 6502 Grand Teton Plz Ste 204, Madison, WI 53719-1047 | 2015-01-05 |
| 1164810909 | Dana Brunner | Marriage & Family Therapist | 6502 Grand Teton Plz Ste 204, Madison, WI 53719-1047 | 2015-01-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689271801 | Jessica Seidel | Registered Nurse | 1015 Gammon Lane, Madison, WI 53719 | 2020-10-01 |
| 1376168989 | 360 Wellness LLC | Physical Therapist | 504 S Yellowstone Lane, Madison, WI 53719 | 2020-06-09 |
| 1932744067 | Sara Ruiz | Marriage & Family Therapist | Clock Tower Office Park, 6333 Odana Rd, #20, Madison, WI 53719 | 2019-11-13 |
| 1700436466 | David R. Gosling | Counselor | 702 South High Point Road #209, Madison, WI 53719 | 2019-09-16 |
| 1285289587 | Clifton Leo Davis Jr. | Counselor | 6417 O Dana Rd #5, Madison, WI 53719 | 2019-08-05 |
| 1679127278 | Akillah Jamillah Wali | Psychologist | 6417 Odana Rd Suite 5, Madison, WI 53719 | 2019-07-31 |
| 1689230211 | Brandy Georgecopeland | Marriage & Family Therapist | 6417 Odana Rd. Ste 5, Madison, WI 53719 | 2019-05-20 |
| 1275016826 | Kelsey Andersen | Physical Therapist | 504 S. Yellowstone Lane, Madison, WI 53719 | 2018-09-10 |
| 1740797190 | Catelyn Schwerke | Social Worker | 3848 Maple Grove Dr, Apt 307, Madison, WI 53719 | 2018-01-08 |
| 1922519008 | Mary Jane Cruz Delorme | Registered Nurse | 6831 Mader Dr. #210, #210, Madison, WI 53719 | 2017-10-17 |
| Find all providers in zip 53719 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578770 | Sunshine Holstein | Counselor | 467 Main St Fl 4, Madison, WV 25130-2200 | 2020-11-05 |
| 1619589538 | Pamela Peoples | Counselor | 1888 Main St Ste C-189, Madison, MS 39110-6337 | 2020-08-21 |
| 1487278404 | Gillian Vandien | Counselor | 2701 International Ln Ste 205, Madison, WI 53704-3126 | 2020-06-05 |
| 1134740210 | Amy C Nicholson | Counselor | 720 Hill St Ste 230, Madison, WI 53705-3539 | 2020-04-30 |
| 1902435308 | Jeffrey Joseph Bopp | Counselor | 518 Diving Hawk Trl, Madison, WI 53713-3380 | 2020-04-07 |
| 1881222313 | Christopher Gabriel Krell | Counselor | 133 Se Macon St, Madison, FL 32340-2986 | 2020-03-30 |
| 1174153381 | Kristine Fernerud | Counselor | 77 Legend Hill Rd, Madison, CT 06443-1877 | 2020-01-16 |
| 1568008886 | Avery Reven Kansteiner | Counselor | 105 Ski Court, Madison, WI 53713 | 2019-11-21 |
| 1124661996 | Lillian A Carroll | Counselor | 502 Pflaum Rd, Madison, WI 53716-2163 | 2019-10-23 |
| 1700436466 | David R. Gosling | Counselor | 702 South High Point Road #209, Madison, WI 53719 | 2019-09-16 |
| Find all providers in MADISON | ||||
Please comment or provide details below to improve the information on STACY L SULLIVAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.