Shayne Thomas Kelley
NPI 1063878130ActiveIndividual· Clinic/Center, Mental Health (Including Community Mental Health Center)· Thousand Oaks, CA
Clinic/Center, Mental Health (Including Community Mental Health Center) with Sud Specialty Group - Ca, practicing in Thousand Oaks, California. Enrolled in Medicare as practitioner - mental health counselor.
Overview
| NPI | 1063878130 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Sole proprietor | Yes |
| NPI issued | Jan 5, 2016 |
| Last updated in NPPES | Apr 25, 2024 |
| Certified by provider | Apr 25, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Clinic/Center, Mental Health (Including Community Mental Health Center) Primary | 261QM0801X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Mental Health Counselor (CA) |
|---|
Education and affiliations
| Graduation year | 2019 |
|---|---|
| Medicare specialty | Mental Health Counselor |
Medical group
- Sud Specialty Group - CaSanta Clara, CA · 568 clinicians
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