Provider Demographics
NPI:1942042544
Name:FILLEY, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:FILLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5574 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2608
Mailing Address - Country:US
Mailing Address - Phone:760-560-7579
Mailing Address - Fax:
Practice Address - Street 1:11100 SAN PABLO AVE STE 205
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2100
Practice Address - Country:US
Practice Address - Phone:760-560-7579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty