Kelly Gene Coburn, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

112266 Issued in CA

Practice address

401 W Civic Center Dr Ste 600
Santa Ana, CA 92701-4515

Phone

(714) 850-8405

NPI assigned

Oct 11, 2012

Last updated

May 26, 2021By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• County of Orange

  dba Health Care Agency

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Santa Ana, CA
  • NPI 1104963347
  NPD
• County of Orange

  dba AMHS Crisis Stabilization Unit

  • Adult Mental Health Clinic/Center
  • Santa Ana, CA
  • NPI 1598025793
  NPD
• County of Orange

  dba AMHS Westminster

  • Adult Mental Health Clinic/Center
  • Westminster, CA
  • NPI 1649317116
  NPD

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

{
    "created_epoch": "1349913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1750633970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2035 E BALL RD",
            "address_2": "STE. 100-A",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928065159",
            "telephone_number": "714-517-6152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W CIVIC CENTER DR STE 600",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927014515",
            "telephone_number": "714-850-8405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBURN",
        "first_name": "KELLY",
        "middle_name": "GENE",
        "name_prefix": "Mr.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-11",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "112266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coastal Communities Hospital
• Coastal Emergency Physicians a Medical Corporation
• Coastal Heart, Inc (Coastal Heart Medical Group)
• Coastal Radiology
• Coastline Surgery Center Inc.
• Colleen Cochran, BCBA
• Aidan Cockerill
• Ashley Noelle Cocking
• Natalie P Cocoziello, APRN-FNP
• Jessica Moreno Codde

• Marriage & Family Therapist in Santa Ana, CA
• Providers in Santa Ana, 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 May 26, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.