Provider Demographics
NPI:1538365978
Name:KAHLE, BRENTON DEAN (MS, MFT)
Entity type:Individual
Prefix:
First Name:BRENTON
Middle Name:DEAN
Last Name:KAHLE
Suffix:
Gender:M
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5730
Mailing Address - Country:US
Mailing Address - Phone:503-325-5731
Mailing Address - Fax:503-325-5731
Practice Address - Street 1:4422 NE DEVILS LAKE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-5000
Practice Address - Country:US
Practice Address - Phone:541-265-4196
Practice Address - Fax:541-994-1882
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0501106H00000X
CA17890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist