Melissa Kaye Coble, PSY.D.

Key facts

NPI

1780613596

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Psychologist 103TC0700X

License

4582 (MN)

Practice address

7601 Wayzata Blvd
St Louis Park, MN 55426-1623

Phone

(612) 223-8898

NPI assigned

Jul 2, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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

• Five Rivers Mental Health LLC Mental Health Clinic/Center (Including Community Mental Health Center) · Mankato, MN · NPI 1689111601
  NPD

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

Other names

• Melissa Kaye Hagen Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 13, 2023.

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1780613596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7601 WAYZATA BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261623",
            "telephone_number": "612-223-8898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 WAYZATA BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261623",
            "telephone_number": "612-223-8898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBLE",
        "first_name": "MELISSA",
        "middle_name": "KAYE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-02",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "4582",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4582",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "4582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "148423100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "HAGEN",
            "middle_name": "KAYE",
            "credential": "LP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Gerri Lee Clements, CNM
• Sarah Clewett
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• Jill Christine Coggins, RN, CNM
• Elissa A Cohen, DPT
• Jacob Cohen, PA
• Steven Marc Cohn, D.C.

All providers in St Louis Park, MN · Clinical Psychologist in Minnesota