Provider Demographics
NPI:1508294588
Name:MARY JO KAHLER, LLC
Entity Type:Organization
Organization Name:MARY JO KAHLER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:301-651-4374
Mailing Address - Street 1:10230 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1400
Mailing Address - Country:US
Mailing Address - Phone:301-651-4637
Mailing Address - Fax:301-439-4299
Practice Address - Street 1:10230 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1400
Practice Address - Country:US
Practice Address - Phone:301-651-4637
Practice Address - Fax:301-439-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR035458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD490047Medicare PIN