Provider Demographics
NPI:1134639388
Name:THERESA C. KIRA, PSYD, A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:THERESA C. KIRA, PSYD, A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIRA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:415-417-1847
Mailing Address - Street 1:870 MARKET ST STE 800
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-2903
Mailing Address - Country:US
Mailing Address - Phone:415-417-1847
Mailing Address - Fax:
Practice Address - Street 1:870 MARKET ST STE 800
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-2903
Practice Address - Country:US
Practice Address - Phone:415-417-1847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health