Provider Demographics
NPI:1245375393
Name:KAYLER, KIRA SUE (MFC 46211)
Entity type:Individual
Prefix:MS
First Name:KIRA
Middle Name:SUE
Last Name:KAYLER
Suffix:
Gender:F
Credentials:MFC 46211
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2567 BELLEVUE RNCH
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5024
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46211101YM0800X
CALMFT46211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710OtherMEDICAL PROVIDER NUMBER