Provider Demographics
NPI:1306625876
Name:KHALSA PSYCHOLOGY PLLC
Entity type:Organization
Organization Name:KHALSA PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KARAMBIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALSA
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:928-985-8550
Mailing Address - Street 1:2700 S WOODLANDS VILLAGE BLVD
Mailing Address - Street 2:STE 300 PMB 295
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:192-898-5855
Mailing Address - Fax:
Practice Address - Street 1:709 N HUMPHREYS
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-985-8550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty