Carly Ketchum, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

81406 Issued in CA

Practice address

30200 Rancho Viejo Rd Ste D
San Juan Capistrano, CA 92675-1560

Phone

(949) 391-1812

NPI assigned

Jun 28, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 30, 2024 through Dec 30, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Marriage Made Better Relationship Counseling

  • Community/Behavioral Health Agency
  • San Juan Capistrano, CA
  • NPI 1235580556
  NPD Authorized official

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

{
    "created_epoch": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1285085597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 CORTE VIDRIOSA",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926737009",
            "telephone_number": "949-391-1812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30200 RANCHO VIEJO RD STE D",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751560",
            "telephone_number": "949-391-1812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETCHUM",
        "first_name": "CARLY",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-28",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "81406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katalin Janosi-Fair, DMD, Inc
• Karen Katzmark, MT
• Erin Kaupp
• Kelly McKinnon & Associates, Inc.
• Kasey Susan Franks Kessler, PPS
• Keystone Care LLC
• Kfi Speech Therapy Professional Corporation
• Kfi Speech Therapy, Professional Corporation
• Naz Khatiblou, DDS
• Chet Khay, NP

• Marriage & Family Therapist in San Juan Capistrano, CA
• Providers in San Juan Capistrano, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.