Provider Demographics
NPI:1215667076
Name:HAWK, KELSEY MCPHERRIN (LMFT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MCPHERRIN
Last Name:HAWK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1264
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93002-1264
Mailing Address - Country:US
Mailing Address - Phone:805-341-3961
Mailing Address - Fax:
Practice Address - Street 1:2580 E MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2640
Practice Address - Country:US
Practice Address - Phone:805-341-3961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC11718101Y00000X, 101YM0800X
CALMFT147981106H00000X
CA133179106H00000X
CAAMFT133179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist