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CARLY KETCHUM LMFT
NPI 1285085597
Marriage & Family Therapist in San Juan Capistrano, CA

Active since June 28, 2016Opted out of Medicare · through Dec 30, 2026
30200 RANCHO VIEJO RD STE D, SAN JUAN CAPISTRANO, CA 92675(949) 391-1812 Get Directions Write a Review

NPPES record last updated: September 10, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 10, 2020, Jun 28, 2016 (2 updates tracked since 2016).

About Carly Ketchum Lmft NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CARLY KETCHUM LMFT (NPI 1285085597) is an individual marriage & family therapist in San Juan Capistrano, California, licensed in California (81406) and active in the NPI registry since June 2016. She has opted out of Medicare through December 30, 2026.

NPPES Registry Identity

NPI1285085597
Entity TypeIndividualFemale
Primary Taxonomy106H00000X
Provider Legal NameCARLY KETCHUMCredential: LMFT
Location Address30200 RANCHO VIEJO RD STE DSan Juan Capistrano, CA 92675-1560
Mailing Address47 Corte VidriosaSan Clemente, CA 92673-7009 · (949) 391-1812
Phone(949) 391-1812
Sole ProprietorNo
Enumeration DateJune 28, 2016
Last NPPES UpdateSeptember 10, 20202 updates tracked since enumeration
NPPES CertifiedSeptember 10, 2020
✔ NPI 1285085597 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers
Taxonomy Code106H00000X
License✔ Licensed in CA · 81406
Definition
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.
30200 RANCHO VIEJO RD STE D, San Juan Capistrano, CA 92675
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Carly Ketchum Lmft has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 30, 2024 through December 30, 2026.

Opt-Out Effective DateDecember 30, 2024
Opt-Out In Effect ThroughDecember 30, 2026Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JANICE AVALONE
Marriage & Family Therapist
30200 RANCHO VIEJO RD STE D
SAN JUAN CAPISTRANO, CA 92675
Orange County (949) 495-1310
MARRIAGE & FAMILY THERAPY OF MIND-BODY WELLNESS, INC.
Clinic/Center (Mental Health (Including Community Mental Health Center))
30200 RANCHO VIEJO RD STE D
SAN JUAN CAPISTRANO, CA 92675
Orange County (949) 310-6460
LAURA LEE TOWNSEND
Marriage & Family Therapist
30200 RANCHO VIEJO RD STE D
SAN JUAN CAPISTRANO, CA 92675
Orange County (949) 373-5890

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Carly Ketchum's NPI number?

The NPI number for Carly Ketchum is 1285085597. It was assigned to this individual provider in the NPPES registry on June 28, 2016.

Where is Carly Ketchum located?

Carly Ketchum practices at 30200 Rancho Viejo Rd Ste D, San Juan Capistrano, CA 92675. The listed phone number is (949) 391-1812.

What is Carly Ketchum's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Is Carly Ketchum enrolled in Medicare?

No. Carly Ketchum has opted out of Medicare through December 30, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Carly Ketchum was last updated on September 10, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.