Active NPI
Marie Welborn, PH.D.
- Clinical Psychologist
- Minneapolis, MN
National Provider Identifier
1083740286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP4371
- Practice address
- 1516 W Lake St
Minneapolis, MN 55408-2554 - Phone
- (612) 824-4123
- Fax
- (952) 829-8005
- NPI assigned
- Feb 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP4371 | MN | Primary |
| Clinical Psychologist | 103TC0700X | PSY15185 | CA |
Addresses
Primary practice location
1516 W Lake St
Minneapolis, MN 55408-2554
Mailing address
PO Box 24625
Edina, MN 55424-0625
Phone (612) 824-4123
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY15185 | CA | MD | Clinical Psychologist |
| LP4371 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083740286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 24625",
"city": "EDINA",
"state": "MN",
"postal_code": "554240625",
"telephone_number": "612-824-4123",
"fax_number": "952-829-8005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1516 W LAKE ST",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554082554",
"telephone_number": "612-824-4123",
"fax_number": "952-829-8005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELBORN",
"first_name": "MARIE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP4371",
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY15185",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.