Healthcare Provider Details

I. General information

NPI: 1972905602
Provider Name (Legal Business Name): KELSEY BROOKE MCKENZIE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 RALSTON ST STE 100
VENTURA CA
93003-7847
US

IV. Provider business mailing address

5740 RALSTON ST STE 100
VENTURA CA
93003-7847
US

V. Phone/Fax

Practice location:
  • Phone: 805-289-3100
  • Fax:
Mailing address:
  • Phone: 805-289-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY32568
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: