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KELSEY LOUDERBACK
NPI 1558247189
Marriage & Family Therapist in San Rafael, CA

Active since August 11, 2025Opted out of Medicare · through Feb 23, 2028
136 SURREY LN, SAN RAFAEL, CA 94903(415) 827-7761 Get Directions Write a Review

NPPES record last updated: August 11, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Kelsey Louderback NPPES

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

KELSEY LOUDERBACK (NPI 1558247189) is an individual marriage & family therapist in San Rafael, California, licensed in California (156716) and active in the NPI registry since August 2025. She has opted out of Medicare through February 23, 2028.

NPPES Registry Identity

NPI1558247189
Entity TypeIndividualFemale
Primary Taxonomy106H00000X
Provider Legal NameKELSEY LOUDERBACK
Location Address136 SURREY LNSan Rafael, CA 94903-3227
Mailing Address136 Surrey LnSan Rafael, CA 94903-3227 · (415) 827-7761
Phone(415) 827-7761
Sole ProprietorYes
Enumeration DateAugust 11, 2025
NPPES CertifiedAugust 11, 2025
✔ NPI 1558247189 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 · 156716
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.
136 SURREY LN, San Rafael, CA 94903
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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

Kelsey Louderback 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 February 23, 2026 through February 23, 2028.

Opt-Out Effective DateFebruary 23, 2026
Opt-Out In Effect ThroughFebruary 23, 2028Opt-out affidavits renew automatically every two years unless cancelled

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 Kelsey Louderback's NPI number?

The NPI number for Kelsey Louderback is 1558247189. It was assigned to this individual provider in the NPPES registry on August 11, 2025.

Where is Kelsey Louderback located?

Kelsey Louderback practices at 136 Surrey Ln, San Rafael, CA 94903. The listed phone number is (415) 827-7761.

What is Kelsey Louderback's specialty?

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

Is Kelsey Louderback enrolled in Medicare?

No. Kelsey Louderback has opted out of Medicare through February 23, 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 Kelsey Louderback was last updated on August 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months 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.