Provider Demographics
NPI:1972901858
Name:KHALSA, VIRIAM SINGH
Entity Type:Individual
Prefix:
First Name:VIRIAM
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 1:2727 MLK BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5901
Mailing Address - Country:US
Mailing Address - Phone:541-682-4777
Mailing Address - Fax:541-682-4732
Practice Address - Street 1:2727 MLK BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5901
Practice Address - Country:US
Practice Address - Phone:541-682-4777
Practice Address - Fax:541-682-4732
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst