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

Mr. Shayne Thomas Kelley

Individual provider Mental Health Clinic/Center (Including Community Mental Health Center) · NPI 1063878130

Mr. Shayne Thomas Kelley is a Mental Health Counselor in Thousand Oaks, California. Qualified in 2019, 7 years ago. Practices with Sud Specialty Group - Ca, a 499-clinician group and accepts Medicare assignment.

Years since qualifying
7
In the registry since
2016
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Practice location Address checks out

187 E Wilbur Rd Ste 14
Thousand Oaks, CA 91360-7938
Phone: (818) 253-4150
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Clinic/Center (Including Community Mental Health Center) (primary) Taxonomy 261QM0801X

Record details

NPI number1063878130
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJanuary 5, 2016
Last updated in NPPESApril 25, 2024
Certification dateApril 25, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Sud Specialty Group - Ca — 499 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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