Healthcare Provider Details

I. General information

NPI: 1306328489
Provider Name (Legal Business Name): KIRA S. KAYLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5233 SAN LUIS AVE
SANTA ROSA CA
95409-2804
US

IV. Provider business mailing address

5233 SAN LUIS AVE
SANTA ROSA CA
95409-2804
US

V. Phone/Fax

Practice location:
  • Phone: 415-497-8780
  • Fax:
Mailing address:
  • Phone: 415-497-8780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number46211
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: KIRA S KAYLER
Title or Position: OWNER
Credential: LMFT
Phone: 415-497-8780