Basic Information
| Provider Information | |||||||||
| NPI: | 1487832192 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAHLE | ||||||||
| FirstName: | M JACKSON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 129 SPRAY AVE | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939403411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7073379008 | ||||||||
| FaxNumber: | 8313721693 | ||||||||
| Practice Location | |||||||||
| Address1: | 31685 HIWAY 101 | ||||||||
| Address2: | SALINAS VALLEY STATE PRISON, MENTAL HEALTH | ||||||||
| City: | SOLEDAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316785676 | ||||||||
| FaxNumber: | 8316785660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2008 | ||||||||
| LastUpdateDate: | 02/05/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TF0200X | PSY10634 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Forensic |
No ID Information.