Provider Demographics
NPI:1770040578
Name:CABELDUE, MOLLIMICHELLE KAY (PHD)
Entity Type:Individual
Prefix:
First Name:MOLLIMICHELLE
Middle Name:KAY
Last Name:CABELDUE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 W SLAUGHTER LN STE 107
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5978
Mailing Address - Country:US
Mailing Address - Phone:512-759-8680
Mailing Address - Fax:
Practice Address - Street 1:5900 BALCONES DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-759-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1637103TC0700X
COPSY.0005808103TF0200X
TX38713103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic