Individual provider Active NPI

Mollimichelle Kay Cabeldue, PH.D

  • Clinical Psychologist
  • Austin, TX
National Provider Identifier
1770040578
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
38713 Issued in TX
Practice address
5900 Balcones Drive
Suite 100
Austin, TX 78731
Phone
(512) 759-8680
NPI assigned
Feb 27, 2019
Last updated
Aug 11, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 1637 LA
Clinical Psychologist 103TC0700X 38713 TX Primary
Forensic Psychologist 103TF0200X PSY.0005808 CO

Addresses

Primary practice location

5900 Balcones Drive
Suite 100
Austin, TX 78731

Mailing address

2110 W Slaughter LN Ste 107
Austin, TX 78748-5978
Phone (512) 759-8680

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Apr 11, 2022 through Apr 11, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY.0005808COMDForensic Psychologist
1637LAMDChiropractor
38713TXMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1551225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1770040578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 W SLAUGHTER LN STE 107",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787485978",
            "telephone_number": "512-759-8680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 BALCONES DRIVE",
            "address_2": "SUITE 100",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78731",
            "telephone_number": "512-759-8680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CABELDUE",
        "first_name": "MOLLIMICHELLE",
        "middle_name": "KAY",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-27",
        "last_updated": "2022-08-11",
        "certification_date": "2022-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "LA",
            "license": "1637",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "38713",
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "CO",
            "license": "PSY.0005808",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.