Healthcare Provider Details

I. General information

NPI: 1609860428
Provider Name (Legal Business Name): JAMES JACK KEHR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HQ USAFE/SG UNIT 3050 BOX 130
APO AE
09094-0130
US

IV. Provider business mailing address

PSC 2 BOX 12287
APO AE
09012-0031
US

V. Phone/Fax

Practice location:
  • Phone: 496371477318
  • Fax: 496371479882
Mailing address:
  • Phone: 496371477318
  • Fax: 496371479882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 13710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: