Provider Demographics
NPI:1558405126
Name:PETALUMA PEOPLE SERVICES CENTER
Entity Type:Organization
Organization Name:PETALUMA PEOPLE SERVICES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COUNSELING AND
Authorized Official - Prefix:MS
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAYLER
Authorized Official - Suffix:
Authorized Official - Credentials:MFC 46211
Authorized Official - Phone:707-765-8488
Mailing Address - Street 1:1500 PETALUMA BLVD. SOUTH
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-0000
Mailing Address - Country:US
Mailing Address - Phone:707-765-8488
Mailing Address - Fax:707-765-8482
Practice Address - Street 1:1500 PETALUMA BLVD. SOUTH
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-0000
Practice Address - Country:US
Practice Address - Phone:707-765-8488
Practice Address - Fax:707-765-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARU49719OtherMEDICAL