NPIMap

Organization Active NPI

Center for Collaborative Health PLLC

  • Counseling Psychologist
  • Edina, MN
National Provider Identifier
1417328808
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
MN5396 Issued in MN
Legal business name
CENTER FOR COLLABORATIVE HEALTH PLLC
Practice address
7300 Metro Blvd
Suite 400
Edina, MN 55439-2468
Phone
(612) 425-0090
Fax
(612) 425-1580
NPI assigned
Oct 12, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

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

Authorized official

Name
Nicole J Slavik, PSYD, LPNPI 1609210251
Title
Office Manager
Phone
(612) 425-0092

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC1900X MN5396 MN Primary
Counseling PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC1900X MN5609 MN

Addresses

Primary practice location

7300 Metro Blvd
Suite 400
Edina, MN 55439-2468

Mailing address

7300 Metro Blvd
Suite 400
Edina, MN 55439-2468
Phone (612) 425-0090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220728003405 MN Part B Supplier - Clinic/Group Practice 2365824976 Receives reassigned benefits from 1 practitioner
Practice locations: Edina, MN

National Provider Directory

National Provider Directory

Locations

7300 Metro Blvd
Ste 695
Edina, MN 55439

7300 Metro Blvd
Ste 400
Minneapolis, MN 55439
Phone (612) 425-0090

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1444608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732233600000",
    "number": "1417328808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 METRO BLVD",
            "address_2": "SUITE 400",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554392468",
            "telephone_number": "612-425-0090",
            "fax_number": "612-425-1580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 METRO BLVD",
            "address_2": "SUITE 400",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554392468",
            "telephone_number": "612-425-0090",
            "fax_number": "612-425-1580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR COLLABORATIVE HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-12",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A",
        "authorized_official_last_name": "SLAVIK",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "612-425-0092",
        "authorized_official_credential": "PSYD, LP"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "MN5396",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": "MN",
            "license": "MN5609",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.