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POLLY S ELY MFT
NPI 1780023762
Marriage & Family Therapist in Tiburon, CA

Active since June 22, 2013Opted out of Medicare · through Jan 1, 2028
145 ESPERANZA ST, TIBURON, CA 94920(415) 233-6866 Get Directions Write a Review

NPPES record last updated: October 23, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 9, 2021, Nov 24, 2020, May 15, 2020 (3 updates tracked since 2020).

About Polly S Ely Mft NPPES

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

POLLY S ELY MFT (NPI 1780023762) is an individual marriage & family therapist in Tiburon, California, licensed in California (53579) and active in the NPI registry since June 2013. She has opted out of Medicare through January 1, 2028.

NPPES Registry Identity

NPI1780023762
Entity TypeIndividualFemale
Primary Taxonomy106H00000X
Provider Legal NamePOLLY S ELYCredential: MFT
Location Address145 ESPERANZA STTiburon, CA 94920-1914
Mailing Address145 Esperanza StTiburon, CA 94920-1914 · (415) 706-7637
Phone(415) 233-6866
Sole ProprietorNo
Enumeration DateJune 22, 2013
Last NPPES UpdateOctober 23, 20243 updates tracked since enumeration
NPPES CertifiedOctober 21, 2024
✔ NPI 1780023762 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 · 53579
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.
145 ESPERANZA ST, Tiburon, CA 94920
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Other Names 1

Other Name (5)Polly S Ely

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Polly S Ely Mft 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 January 1, 2024 through January 1, 2028.

Opt-Out Effective DateJanuary 1, 2024
Opt-Out In Effect ThroughJanuary 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES

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

POLLY ELY, INC.
Community/Behavioral Health
145 ESPERANZA ST
TIBURON, CA 94920
Marin County (415) 233-6866

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 Polly Ely's NPI number?

The NPI number for Polly Ely is 1780023762. It was assigned to this individual provider in the NPPES registry on June 22, 2013. The provider is also known as Polly S Ely.

Where is Polly Ely located?

Polly Ely practices at 145 Esperanza St, Tiburon, CA 94920. The listed phone number is (415) 233-6866.

What is Polly Ely's specialty?

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

Is Polly Ely enrolled in Medicare?

No. Polly Ely has opted out of Medicare through January 1, 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 Polly Ely was last updated on October 23, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 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.