Provider Demographics
NPI:1255153748
Name:HURD, KAYLA FAYE (RECOVERY COACH)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:FAYE
Last Name:HURD
Suffix:
Gender:F
Credentials:RECOVERY COACH
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:FAYE
Other - Last Name:HURD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1563 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2543
Mailing Address - Country:US
Mailing Address - Phone:415-762-3700
Mailing Address - Fax:
Practice Address - Street 1:1221 MARINER DR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94130-1212
Practice Address - Country:US
Practice Address - Phone:619-359-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker