MEDICARE: KELLY TARBELL LMFT

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	106H00000X	Marriage & Family Therapist	149473	CA

General Provider Information

NPI Number	:	1366006454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY TARBELL LMFT

Provider Business Mailing Address
First Line	:	3245 UNIVERSITY AVE STE 1-267
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2009
Country	:	US
Telephone Number	:	619-721-3296
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 KEARNY VILLA RD STE 118
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1574
Country	:	US
Telephone Number	:	619-721-3296
Fax Number	:

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

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	01/08/2026

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Directions to “ KELLY TARBELL LMFT” Practice Location

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