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General NPI Number Information
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NPI Number | 1699825877
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Entity Type | Individual
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Provider Name | SKYELLEN GRACE KULANU PHD
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 45 FRANKLIN ST STE 212
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-6030
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Country | US
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Telephone | 510-922-0284
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Fax |
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Provider Business Mailing Address
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Address Line | 6239 COLLEGE AVE STE 303
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City | OAKLAND
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State | CA
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Zip | 94618-1384
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Country | US
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Telephone | 510-922-0284
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY22942
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License Number State | CA
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