Eric Kelly, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFC 32566 Issued in CA

Practice address

25 Mitchell Blvd Ste 3
San Rafael, CA 94903-2013

Phone

(415) 472-5282

Fax

(415) 472-5534

NPI assigned

Aug 15, 2006

Sex

Male

Sole proprietor

Yes

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Marriage and Family Therapist

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627084800000",
    "number": "1699788133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 MITCHELL BLVD STE 3",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032013",
            "telephone_number": "415-472-5282",
            "fax_number": "415-472-5534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MITCHELL BLVD STE 3",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032013",
            "telephone_number": "415-472-5282",
            "fax_number": "415-472-5534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "ERIC",
        "name_prefix": "Mr.",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2021-07-24",
        "certification_date": "2021-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC 32566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberlie Keller, DO
• Robert W. Keller
• Valerie Irene Keller, MFTI
• Christopher Lyle Ivan Kellogg, MA
• Andrew Edward Kelly, P.T.
• Jeremy Ray Kelsay
• Carmalita Marshall Kemayo
• Michelle Rae Kemp, CERTIFIED PEER
• Maryann Kemper, MFT
• Judith Lynne Kendall, M.A., MFT

• Marriage & Family Therapist in San Rafael, CA
• Providers in San Rafael, 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 Jul 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.