Provider Demographics
NPI:1619001658
Name:KELLEY, VICTOR MURAT (RETIRED)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:MURAT
Last Name:KELLEY
Suffix:
Gender:M
Credentials:RETIRED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MAPLE CT
Mailing Address - Street 2:STE. 250
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3516
Mailing Address - Country:US
Mailing Address - Phone:805-620-8524
Mailing Address - Fax:
Practice Address - Street 1:260 MAPLE CT
Practice Address - Street 2:STE. 250
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3516
Practice Address - Country:US
Practice Address - Phone:805-620-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 12256106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist