=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083857239
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. SAT KAUR KHALSA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2009
-----------------------------------------------------
Last Update Date | 04/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1452 26TH ST SUITE 202
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-3084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-828-2210
-----------------------------------------------------
Fax | 505-820-0197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 E CORONADO RD SUITE 3
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87505-0610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-986-1876
-----------------------------------------------------
Fax | 505-820-0197
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC18406
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LPCC0350
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT0349
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------