Provider Demographics
NPI:1487832192
Name:KAHLE, M JACKSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:M JACKSON
Middle Name:
Last Name:KAHLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 SPRAY AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3411
Mailing Address - Country:US
Mailing Address - Phone:707-337-9008
Mailing Address - Fax:831-372-1693
Practice Address - Street 1:31685 HIWAY 101
Practice Address - Street 2:SALINAS VALLEY STATE PRISON, MENTAL HEALTH
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960
Practice Address - Country:US
Practice Address - Phone:831-678-5676
Practice Address - Fax:831-678-5660
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10634103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic