Provider Demographics
NPI:1033620455
Name:KHAN, GHAZALA A (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:GHAZALA
Middle Name:A
Last Name:KHAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 10482
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-0482
Mailing Address - Country:US
Mailing Address - Phone:1510-364-1402
Mailing Address - Fax:
Practice Address - Street 1:115 TOWN AND COUNTRY
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94568-9456
Practice Address - Country:US
Practice Address - Phone:151-036-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138678101YM0800X
CALMFT100117106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health