Provider Demographics
NPI:1134790447
Name:KHALSA, HARIMANDIR KAUR
Entity type:Individual
Prefix:
First Name:HARIMANDIR
Middle Name:KAUR
Last Name:KHALSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4204
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-0204
Mailing Address - Country:US
Mailing Address - Phone:510-829-5145
Mailing Address - Fax:
Practice Address - Street 1:150 N WIGET LN STE 201
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2434
Practice Address - Country:US
Practice Address - Phone:925-315-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist