Mary Kelso, PH.,D. Inc

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY10466 Issued in CA

Legal business name

MARY KELSO, PH.,D. INC

Practice address

325 E Hillcrest Dr
Ste 115
Thousand Oaks, CA 91360-5828

Phone

(805) 379-9600

Fax

(951) 245-0309

NPI assigned

Feb 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mary Kelso, PH.D.NPI 1154312189

Title

Psychologist

Phone

(805) 379-9600

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Kelso, PH.D.

  • Clinical Psychologist
  • Thousand Oaks, CA
  • NPI 1154312189
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190937600000",
    "number": "1164566881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7251",
            "city": "WESTLAKE VILLAGE",
            "state": "CA",
            "postal_code": "913597251",
            "telephone_number": "805-379-9600",
            "fax_number": "951-245-0309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 E HILLCREST DR",
            "address_2": "STE 115",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913605828",
            "telephone_number": "805-379-9600",
            "fax_number": "951-245-0309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY KELSO, PH.,D. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2007-09-28",
        "status": "A",
        "authorized_official_last_name": "KELSO",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "805-379-9600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY10466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bianca Nicole Martinez, LMFT
• Bianca Noelle Martinez
• Laura Martinez, BA
• Leticia Martinez, PTA
• Joelle Martino, PSYD
• Jane Maryoung, R.P.T.
• Vandana K Master, D.D.S.
• Tracy K Matalon, MSN, FNP
• Rami Matar, MD
• Alex Matthew Matavosian, PA-C

• Clinical Psychologist in Thousand Oaks, CA
• Providers in Thousand Oaks, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.