Healthcare Provider Details

I. General information

NPI: 1023601580
Provider Name (Legal Business Name): KYLA DIANE GREEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 LINCOLN AVE STE 102B
SAN RAFAEL CA
94901-2141
US

IV. Provider business mailing address

1330 LINCOLN AVE STE 102B
SAN RAFAEL CA
94901-2141
US

V. Phone/Fax

Practice location:
  • Phone: 415-847-5797
  • Fax:
Mailing address:
  • Phone: 415-847-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number152743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: