Individual provider Active NPI

Marie Nyonnoh-Clay Cassell Koffa, LADC, LPCC

  • Mental Health Counselor
  • New Hope, MN
National Provider Identifier
1699415216
Registry record updated Mar 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
4182 Issued in MN
Practice address
5555 Boone Ave N
New Hope, MN 55428-3636
Phone
(651) 774-0011
Fax
(651) 774-0606
NPI assigned
Mar 31, 2022
Last updated
Mar 18, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 4182 MN Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 306196 MN

Addresses

Primary practice location

5555 Boone Ave N
New Hope, MN 55428-3636

Mailing address

3000 Ames Crossing Rd Ste 600
Eagan, MN 55121-2570
Phone (651) 774-0011

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20260326003202 MN Practitioner - Mental Health Counselor 9739664863 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3000 Ames Crossing Rd
Suite 600
Eagan, MN 55121-2519

8060 State Hwy 55
Suite 100
Rockford, MN 55373

8060 State Hwy 55
Suite 100
Rockford, MN 55373-9407

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
306196MNMDAddiction (Substance Use Disorder) Counselor

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1648684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773792000000",
    "number": "1699415216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 AMES CROSSING RD STE 600",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551212570",
            "telephone_number": "651-774-0011",
            "fax_number": "651-774-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 BOONE AVE N",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554283636",
            "telephone_number": "651-774-0011",
            "fax_number": "651-774-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOFFA",
        "first_name": "MARIE",
        "middle_name": "NYONNOH-CLAY CASSELL",
        "name_prefix": "Mrs.",
        "credential": "LADC, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-31",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "4182",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "306196",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Hope, MN

Sources for this page

Verify at the official NPI Registry.