Provider Demographics
NPI:1619221785
Name:KHALSA, RAMA K (MFT)
Entity type:Individual
Prefix:MS
First Name:RAMA
Middle Name:K
Last Name:KHALSA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:RAMA
Other - Middle Name:KIRN
Other - Last Name:KHALSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:4904 BELLEVUE ST
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2667
Mailing Address - Country:US
Mailing Address - Phone:831-251-1939
Mailing Address - Fax:831-475-6047
Practice Address - Street 1:4904 BELLEVUE ST
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2667
Practice Address - Country:US
Practice Address - Phone:831-251-1939
Practice Address - Fax:831-475-6047
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13357106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist