Healthcare Provider Details

I. General information

NPI: 1992018469
Provider Name (Legal Business Name): BEACHSIDE ADULT AND FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 TELEGRAPH RD STE 200
VENTURA CA
93003-3250
US

IV. Provider business mailing address

3160 TELEGRAPH RD STE 200
VENTURA CA
93003-3250
US

V. Phone/Fax

Practice location:
  • Phone: 805-642-4611
  • Fax: 805-585-3241
Mailing address:
  • Phone: 805-642-4611
  • Fax: 805-585-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KERRY O'REILLY
Title or Position: CEO
Credential: PSYD, LMFT
Phone: 310-463-5656