Provider Demographics
NPI:1134152523
Name:KHALSA, GURUSHER KAUR (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:GURUSHER
Middle Name:KAUR
Last Name:KHALSA
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457B CARLISLE DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4819
Mailing Address - Country:US
Mailing Address - Phone:703-742-7599
Mailing Address - Fax:703-464-5822
Practice Address - Street 1:457B CARLISLE DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4819
Practice Address - Country:US
Practice Address - Phone:703-742-7599
Practice Address - Fax:703-464-5822
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2131454OtherMAMSI
TX4065098OtherAETNA
DC373287OtherMHN
MD243323000OtherMAGELLAN
MDK3990001OtherCAREFIRSTBLUECROSS
VA146434OtherANTHEMBLUECROSS
VA699849OtherNCPPO
VA146434OtherANTHEMBLUECROSS