Provider Demographics
NPI:1306328489
Name:KIRA S. KAYLER
Entity type:Organization
Organization Name:KIRA S. KAYLER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAYLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:415-497-8780
Mailing Address - Street 1:5233 SAN LUIS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-2804
Mailing Address - Country:US
Mailing Address - Phone:415-497-8780
Mailing Address - Fax:
Practice Address - Street 1:5233 SAN LUIS AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-2804
Practice Address - Country:US
Practice Address - Phone:415-497-8780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA46211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty