Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mary Jacqueline Kellerman, CCJP

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1205190451

Mary Jacqueline Kellerman, CCJP is an Addiction (Substance Use Disorder) Counselor in Tarzana, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2012

Practice location Address checks out

18646 Oxnard St
Tarzana, CA 91356-1411
Phone: (818) 996-1051
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X · Licence CJP980109 (CA)

Record details

NPI number1205190451
Entity typeIndividual (Type 1)
GenderFemale
Credentials CCJP
Sole proprietorYes
NPI enumeratedJuly 2, 2012
Last updated in NPPESMay 17, 2024
Certification dateMay 17, 2024

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