Healthcare Provider Details

I. General information

NPI: 1538365978
Provider Name (Legal Business Name): BRENTON DEAN KAHLE M.S., MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 NE DEVILS LAKE BLVD SUITE 2
LINCOLN CITY OR
97367-5000
US

IV. Provider business mailing address

418 PLEASANT AVE
ASTORIA OR
97103-5730
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-4196
  • Fax: 541-994-1882
Mailing address:
  • Phone: 503-325-5731
  • Fax: 503-325-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0501
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number17890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: