NPIMap

Organization Active NPI

Vayda Mental Health Collaborative PLLC

  • Clinical Psychologist
  • Coon Rapids, MN
National Provider Identifier
1770194417
Registry record updated Sep 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
VAYDA MENTAL HEALTH COLLABORATIVE PLLC
Practice address
299 Coon Rapids Blvd NW Ste 100
Coon Rapids, MN 55433-5869
Phone
(651) 240-2206
Fax
(612) 446-5766
NPI assigned
Aug 16, 2020
Last updated
Sep 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2020

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

Authorized official

Name
Dr. Alise Marie Novak, PSYD, LPNPI 1427500248
Title
Co-Founder
Phone
(651) 240-2206

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X
Family PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TF0000X
Health PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TH0004X
Group Psychotherapy PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP2701X

Addresses

Primary practice location

299 Coon Rapids Blvd NW Ste 100
Coon Rapids, MN 55433-5869

Mailing address

13233 Johnson St NE
Blaine, MN 55434-4171
Phone (612) 382-9781

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL dr.novak@vaydamentalhealth.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260519000075 MN Part B Supplier - Clinic/Group Practice 3375012453 Receives reassigned benefits from 3 practitioners
Practice locations: Coon Rapids, MN

National Provider Directory

National Provider Directory

Locations

299 Coon Rapids Blvd NW
Ste 100
Coon Rapids, MN 55433
Phone (651) 240-2206

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1597536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600387200000",
    "number": "1770194417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13233 JOHNSON ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554344171",
            "telephone_number": "612-382-9781",
            "fax_number": "612-446-5766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 COON RAPIDS BLVD NW STE 100",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335869",
            "telephone_number": "651-240-2206",
            "fax_number": "612-446-5766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VAYDA MENTAL HEALTH COLLABORATIVE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-16",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A",
        "authorized_official_last_name": "NOVAK",
        "authorized_official_first_name": "ALISE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CO-FOUNDER",
        "authorized_official_telephone_number": "651-240-2206",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, LP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "dr.novak@vaydamentalhealth.com",
            "affiliation": "N",
            "endpointDescription": "professional email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "299 Coon Rapids Blvd NW Ste 100",
            "city": "Coon Rapids",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554335869",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; 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.