DR. TARA LEE KELLY PH.D.
NPI 1336155290
Psychologist in Los Angeles, CA

Active since July 31, 2006Opted out of Medicare · through Mar 26, 2028
12304 SANTA MONICA BLVD, SUITE 106, LOS ANGELES, CA 90025(310) 559-3629(310) 559-3620 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Tara Lee Kelly Ph.d. NPPES

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

DR. TARA LEE KELLY PH.D. (NPI 1336155290) is an individual psychologist in Los Angeles, California, licensed in California (PSY 12349) and active in the NPI registry since July 2006. She has opted out of Medicare through March 26, 2028.

NPPES Registry Identity

NPI1336155290
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. TARA LEE KELLYCredential: PH.D.
Location Address12304 SANTA MONICA BLVD, SUITE 106Los Angeles, CA 90025-2551
Mailing Address12304 Santa Monica Blvd, Suite 106Los Angeles, CA 90025-2551 · (310) 559-3629 · Fax (310) 559-3620
Fax(310) 559-3620
Sole ProprietorYes
Enumeration DateJuly 31, 2006
Last NPPES UpdateJuly 8, 2007
NPI 1336155290 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in CA · PSY 12349
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
12304 SANTA MONICA BLVD, Los Angeles, CA 90025

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Opted out of Medicare

Dr. Tara Lee Kelly Ph.d. 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 March 26, 2026 through March 26, 2028.

Opt-Out Effective DateMarch 26, 2026
Opt-Out In Effect ThroughMarch 26, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 20

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

Marriage & Family Therapist
12304 SANTA MONICA BLVD, SUITE 215
LOS ANGELES, CA 90025
Psychologist (Clinical)
12304 SANTA MONICA BLVD, SUITE 211
LOS ANGELES, CA 90025
Counselor
12304 SANTA MONICA BLVD, SUITE 215
LOS ANGELES, CA 90025
Specialist/Technologist
12304 SANTA MONICA BLVD, SUITE 300
W LOS ANGELES, CA 90025
Psychologist (Cognitive & Behavioral)
12304 SANTA MONICA BLVD, SUITE 200
WEST LOS ANGELES, CA 90025
Marriage & Family Therapist
12304 SANTA MONICA BLVD, SUITE 315
LOS ANGELES, CA 90025
Marriage & Family Therapist
12304 SANTA MONICA BLVD, SUITE 327
LOS ANGELES, CA 90025
Behavior Technician
12304 SANTA MONICA BLVD
LOS ANGELES, CA 90025

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 Tara Kelly's NPI number?

The NPI number for Tara Kelly is 1336155290. It was assigned to this individual provider in the NPPES registry on July 31, 2006.

Where is Tara Kelly located?

Tara Kelly practices at 12304 Santa Monica Blvd Suite 106, Los Angeles, CA 90025. The listed phone number is (310) 559-3629.

What is Tara Kelly's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Tara Kelly enrolled in Medicare?

No. Tara Kelly has opted out of Medicare through March 26, 2028. 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 Tara Kelly was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.