Provider Demographics
NPI:1669008868
Name:KHALSA, KARAMBIR SINGH
Entity Type:Individual
Prefix:DR
First Name:KARAMBIR
Middle Name:SINGH
Last Name:KHALSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:928-235-4690
Mailing Address - Fax:
Practice Address - Street 1:709 N HUMPHREYS ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3025
Practice Address - Country:US
Practice Address - Phone:928-985-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0107000103TC0700X
AZPSY-005603103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical