Provider Demographics
NPI:1972905602
Name:MCKENZIE, KELSEY BROOKE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:BROOKE
Last Name:MCKENZIE
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 RALSTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7847
Mailing Address - Country:US
Mailing Address - Phone:805-289-3100
Mailing Address - Fax:
Practice Address - Street 1:5740 RALSTON ST STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7847
Practice Address - Country:US
Practice Address - Phone:805-289-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32568103TC2200X, 103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical