Polly Ely, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

POLLY ELY, INC.

Doing business as

Parent School
The LAB Method

Practice address

145 Esperanza St
Tiburon, CA 94920-1914

Phone

(415) 233-6866

NPI assigned

Apr 13, 2019

Last updated

Jan 23, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Polly Stark Ely, MFTNPI 1780023762

Title

President

Phone

(415) 233-6866

Specialties & licenses 2

Addresses

Other names 2

• Parent School Doing business as
• The LAB Method Doing business as

Locations

Practitioners 1

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.

• Polly S Ely, MFT

  • Marriage & Family Therapist
  • Tiburon, CA
  • NPI 1780023762
  NPD Authorized official

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

{
    "created_epoch": "1555113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611360000000",
    "number": "1609339811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 685",
            "city": "TIBURON",
            "state": "CA",
            "postal_code": "949200685",
            "telephone_number": "415-233-6866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 ESPERANZA ST",
            "city": "TIBURON",
            "state": "CA",
            "postal_code": "949201914",
            "telephone_number": "415-233-6866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLLY ELY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-13",
        "last_updated": "2021-01-23",
        "certification_date": "2021-01-23",
        "status": "A",
        "authorized_official_last_name": "ELY",
        "authorized_official_first_name": "POLLY",
        "authorized_official_middle_name": "STARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "415-233-6866",
        "authorized_official_credential": "MFT"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parent School",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Parent School",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The LAB Method",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristen Nelson, DPT
• Olympic Physical Therapy
• Sherrin Jean Packer-Rosenthal, LMFT, MSW,ASW, PPSC
• Herbert W. Peterson, M. D.
• Alicia Andreis Pflueger, D.C.
• Portofino Labs, Inc (Because Market)
• Dara Grace Post, MPT
• Clara Prigge
• Kendra Radtke
• Timothy M Rankin, M.D.

• Community/Behavioral Health Agency in Tiburon, CA
• Providers in Tiburon, CA by specialty
• Community/Behavioral Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.