Provider Demographics
NPI:1063863413
Name:KHAHRA, AMARDEEP (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMARDEEP
Middle Name:
Last Name:KHAHRA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 W GLEN OAKS LN STE 171
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3371
Mailing Address - Country:US
Mailing Address - Phone:262-236-9588
Mailing Address - Fax:
Practice Address - Street 1:1017 W GLEN OAKS LN STE 171
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3371
Practice Address - Country:US
Practice Address - Phone:262-236-9588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI405557103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical