Provider Demographics
NPI:1609398353
Name:KHETARPAL, NEVIDA (MA , LMFT)
Entity Type:Individual
Prefix:
First Name:NEVIDA
Middle Name:
Last Name:KHETARPAL
Suffix:
Gender:F
Credentials:MA , LMFT
Other - Prefix:MISS
Other - First Name:NEVIDA
Other - Middle Name:
Other - Last Name:KHETARPAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:1336 WHITE OAK LANE
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185
Mailing Address - Country:US
Mailing Address - Phone:630-329-0036
Mailing Address - Fax:
Practice Address - Street 1:900 E DIEHL RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1403
Practice Address - Country:US
Practice Address - Phone:888-428-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166001577106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist