MEDICARE: BRENTON DEAN KAHLE M.S., MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	T0501	OR
2	106H00000X	Marriage & Family Therapist	17890	CA

General Provider Information

NPI Number	:	1538365978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENTON DEAN KAHLE M.S., MFT

Provider Business Mailing Address
First Line	:	418 PLEASANT AVE
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-5730
Country	:	US
Telephone Number	:	503-325-5731
Fax Number	:	503-325-5731

Provider Business Practice Location Address
First Line	:	4422 NE DEVILS LAKE BLVD
Second Line	:	SUITE 2
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-5000
Country	:	US
Telephone Number	:	541-265-4196
Fax Number	:	541-994-1882

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	07/18/2024

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