MEDICARE: DR. TARA LEE KELLY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY 12349	CA

General Provider Information

NPI Number	:	1336155290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA LEE KELLY PH.D.

Provider Business Mailing Address
First Line	:	12304 SANTA MONICA BLVD
Second Line	:	SUITE 106
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2551
Country	:	US
Telephone Number	:	310-559-3629
Fax Number	:	310-559-3620

Provider Business Practice Location Address
First Line	:	12304 SANTA MONICA BLVD
Second Line	:	SUITE 106
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2551
Country	:	US
Telephone Number	:	310-559-3629
Fax Number	:	310-559-3620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

Similar Medicare Providers

1871446070 — JACOBS NEUROBEHAVIORAL CENTER
Practice Location Address:

12304 SANTA MONICA BLVD STE 315
LOS ANGELES, CA
90025-2551

Practice Phone: 818-571-2285
Practice Fax:

1992740807 — DR. JOY E. CARTER-CHASTAIN PH.D.
Practice Location Address:

12304 SANTA MONICA BLVD , # 215-A
LOS ANGELES, CA
90025-2551

Practice Phone: 310-785-7176
Practice Fax: 310-820-4432

1316983562 — DR. RONALD CHARLES BOUTELLE PHD, PSYD
Practice Location Address:

12304 SANTA MONICA BLVD , SUITE 106
LOS ANGELES, CA
90025-2551

Practice Phone: 310-317-6784
Practice Fax: 310-317-6784

1902833932 — DR. THOMAS MARCY BROD MD
Practice Location Address:

12304 SANTA MONICA BLVD , #210
LOS ANGELES, CA
90025-2551

Practice Phone: 310-207-3337
Practice Fax:

1306851076 — BEHNAM PARTOVI PHD
Practice Location Address:

12304 SANTA MONICA BLVD , # 315
LOS ANGELES, CA
90025-2551

Practice Phone: 310-930-7500
Practice Fax: 310-453-3909

1033127824 — RICHARD ALAN GOTTFRIED MFT
Practice Location Address:

12304 SANTA MONICA BLVD , SUITE 215
LOS ANGELES, CA
90025-2551

Practice Phone: 310-207-5177
Practice Fax: 310-207-7919

Directions to “ DR. TARA LEE KELLY PH.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.