Active NPI
Tara Lee Kelly, PH.D.
- Psychologist
- Los Angeles, CA
National Provider Identifier
1336155290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 12349
- Practice address
- 12304 Santa Monica Blvd
Suite 106
Los Angeles, CA 90025-2551 - Phone
- (310) 559-3629
- Fax
- (310) 559-3620
- NPI assigned
- Jul 31, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 12349 | CA | Primary |
Addresses
Primary practice location
12304 Santa Monica Blvd
Suite 106
Los Angeles, CA 90025-2551
Mailing address
12304 Santa Monica Blvd
Suite 106
Los Angeles, CA 90025-2551
Phone (310) 559-3629
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 26, 2026 through Mar 26, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 12349 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1336155290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12304 SANTA MONICA BLVD",
"address_2": "SUITE 106",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900252551",
"telephone_number": "310-559-3629",
"fax_number": "310-559-3620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12304 SANTA MONICA BLVD",
"address_2": "SUITE 106",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900252551",
"telephone_number": "310-559-3629",
"fax_number": "310-559-3620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "TARA",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 12349",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.