Provider Demographics
NPI:1699825877
Name:KULANU, SKYELLEN GRACE (PHD)
Entity type:Individual
Prefix:DR
First Name:SKYELLEN
Middle Name:GRACE
Last Name:KULANU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6239 COLLEGE AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1384
Mailing Address - Country:US
Mailing Address - Phone:510-922-0284
Mailing Address - Fax:
Practice Address - Street 1:45 FRANKLIN ST STE 212
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6030
Practice Address - Country:US
Practice Address - Phone:510-922-0284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22942103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist