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Individual

MUKTA KAUR KHALSA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMHC, LADAC

Contact information

Practice address
1 RAM DAS GURU PL, ESPANOLA, NM 87532-8213
(505) 699-6505
Mailing address
PO BOX 94508, ALBUQUERQUE, NM 87199-4508
(505) 384-7352
(505) 274-7338

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAD3416
NM
101YM0800X
Mental Health Counselor
Primary
0397
NM

Other

Enumeration date
11/13/2018
Last updated
11/13/2018
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