=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992018469
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEACHSIDE ADULT AND FAMILY THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2010
-----------------------------------------------------
Last Update Date | 12/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3160 TELEGRAPH RD STE 200
-----------------------------------------------------
City | VENTURA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93003-3250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-642-4611
-----------------------------------------------------
Fax | 805-585-3241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3160 TELEGRAPH RD STE 200
-----------------------------------------------------
City | VENTURA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93003-3250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-642-4611
-----------------------------------------------------
Fax | 805-585-3241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KERRY O'REILLY
-----------------------------------------------------
Credential | PSYD, LMFT
-----------------------------------------------------
Telephone | 310-463-5656
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 102L00000X
-----------------------------------------------------
Taxonomy Name | Psychoanalyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------