Individual provider Active NPI

Kelsey Anne Holiday, PHD

  • Clinical Psychologist
  • San Diego, CA
National Provider Identifier
1639882970
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY33681 Issued in CA
Practice address
11120 E Ocean Air Dr Ste 101-114
San Diego, CA 92130-4683
Phone
(619) 736-8901
NPI assigned
Jan 2, 2023
Last updated
Jul 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY33681 CA Primary

Addresses

Primary practice location

11120 E Ocean Air Dr Ste 101-114
San Diego, CA 92130-4683

Mailing address

11120 E Ocean Air Dr Ste 101-114
San Diego, CA 92130-4683
Phone (619) 736-8901

Other practice location 1

2001 S Barrington Ave Ste 204
Los Angeles, CA 90025-5385
Phone (619) 736-8901

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jul 24, 2023 through Jul 24, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY33681CAMDClinical Psychologist
33681CAMDPediatric Physical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1672617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752710400000",
    "number": "1639882970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11120 E OCEAN AIR DR STE 101-114",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921304683",
            "telephone_number": "619-736-8901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11120 E OCEAN AIR DR STE 101-114",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921304683",
            "telephone_number": "619-736-8901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2001 S Barrington Ave Ste 204",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900255385",
            "country_code": "US",
            "telephone_number": "619-736-8901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLIDAY",
        "first_name": "KELSEY",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-01-02",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY33681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.