Provider Demographics
NPI:1992383293
Name:KOHLI, PAVIT S
Entity Type:Individual
Prefix:MR
First Name:PAVIT
Middle Name:S
Last Name:KOHLI
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 1:6040 EARLE BROWN DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-4523
Mailing Address - Country:US
Mailing Address - Phone:161-270-7753
Mailing Address - Fax:612-326-6160
Practice Address - Street 1:6040 EARLE BROWN DR STE 300
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-4523
Practice Address - Country:US
Practice Address - Phone:161-270-7753
Practice Address - Fax:612-326-6160
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health