Healthcare Provider Details

I. General information

NPI: 1093882698
Provider Name (Legal Business Name): KELLY A O'BRYAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 S TREMONT ST
OCEANSIDE CA
92054-5309
US

IV. Provider business mailing address

1738 S TREMONT ST
OCEANSIDE CA
92054-5309
US

V. Phone/Fax

Practice location:
  • Phone: 760-439-2800
  • Fax:
Mailing address:
  • Phone: 760-439-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number24966
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY24966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: