Provider Demographics
NPI:1750988390
Name:KHANNA, NICOLE SUJATA (MA LMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SUJATA
Last Name:KHANNA
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:NIKI
Other - Middle Name:
Other - Last Name:KHANNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LMFT
Mailing Address - Street 1:1699 MARKET ST APT 622
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1327
Mailing Address - Country:US
Mailing Address - Phone:415-602-1160
Mailing Address - Fax:
Practice Address - Street 1:1699 MARKET ST APT 622
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1327
Practice Address - Country:US
Practice Address - Phone:415-602-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122099106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist