Cisco Javier Cole, MA, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

4007 Issued in MN

Practice address

8085 Wayzata Blvd Ste 203
St Louis Park, MN 55426-1461

Phone

(612) 296-3800

NPI assigned

Aug 3, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Optimal Brain MN PLLCGroup PAC ID 6709317787, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cisco.cole@phawellness.com

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.

• Optimal Brain MN, PLLC

  • Clinical Psychologist
  • Oakdale, MN
  • NPI 1609614957

  MN

  Medicare reassignment Care Compare group NPD
• Lighthouse Psychological Services Inc

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1548428170

  MN

  Medicare reassignment
• Integrative Health, LLC

  • Multi-Specialty Clinic/Center
  • Oakdale, MN
  • NPI 1396314654
  NPD (past)
• Psychotherapy & Healing Associates

  • Psychologist
  • St Louis Park, MN
  • NPI 1801028972
  NPD (past)

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

{
    "created_epoch": "1659484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1063149656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "969 6TH ST E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551064505",
            "telephone_number": "612-750-6655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8085 WAYZATA BLVD STE 203",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261461",
            "telephone_number": "612-296-3800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1551 Payne Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551303218",
            "country_code": "US",
            "telephone_number": "763-780-3307",
            "fax_number": "833-777-2781",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COLE",
        "first_name": "CISCO",
        "middle_name": "JAVIER",
        "credential": "MA, LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-03",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "4007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cisco.cole@PHAwellness.com",
            "affiliation": "N",
            "endpointDescription": "Secured email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "969 6th St E",
            "city": "Saint Paul",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551064505",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elissa A Cohen, DPT
• Jacob Cohen, PA
• Steven Marc Cohn, D.C.
• Cole Vision Corporation
• Adriana Shaniece Cole
• Pamela Susannah Cole, MSPT, OWS
• Jessica Marie Coleman
• Collective Healing Therapy & Consulting LLC
• Colleen Martens Endrizzi, Inc.
• Colleen Morrissette, PLLC

• All providers in St Louis Park, MN
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.