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Organization

POLLY ELY, INC.

Active
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Organization

POLLY ELY, INC.

Active
Other names
The LAB Method, Parent School
Organization subpart
No

Provider details

NPI number
Authorized official
POLLY STARK ELY MFT (PRESIDENT)
(415) 233-6866
Entity
Organization

Contact information

Practice address
145 ESPERANZA ST, TIBURON, CA 94920-1914
(415) 233-6866
Mailing address
PO BOX 685, TIBURON, CA 94920-0685
(415) 233-6866

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—

Other

Enumeration date
04/13/2019
Last updated
01/23/2021
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