Polly S Ely, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

53579 Issued in CA

Practice address

145 Esperanza St
Tiburon, CA 94920-1914

Phone

(415) 233-6866

NPI assigned

Jun 22, 2013

Last updated

Oct 23, 2024By the provider in NPPES

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

Other names 1

• Polly S Ely Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: polly@thelabmethod.com

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.

• Polly Ely, Inc.

  dba Parent School

  • Community/Behavioral Health Agency
  • Tiburon, CA
  • NPI 1609339811
  NPD Authorized official

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

{
    "created_epoch": "1371859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1780023762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 ESPERANZA ST",
            "city": "TIBURON",
            "state": "CA",
            "postal_code": "949201914",
            "telephone_number": "415-706-7637"
        },
        {
            "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": {
        "last_name": "ELY",
        "first_name": "POLLY",
        "middle_name": "S",
        "credential": "MFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-22",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "53579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Polly@thelabmethod.com",
            "affiliation": "N",
            "endpointDescription": "Clinical Practice email address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "145 Esperanza St",
            "city": "Tiburon",
            "state": "CA",
            "country_code": "US",
            "postal_code": "949201914",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "POLLY",
            "last_name": "ELY",
            "middle_name": "S",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Marriage & Family Therapist in Tiburon, CA
• Providers in Tiburon, 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 Oct 23, 2024; 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.