NPIMap

Organization Active NPI

Modern Psychological Services LLC

  • Adult Mental Health Clinic/Center
  • Alexandria, VA
National Provider Identifier
1902159122
Registry record updated Oct 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
0810004653 Issued in VA
Legal business name
MODERN PSYCHOLOGICAL SERVICES LLC
Practice address
6177 Grovedale CT Ste 100
Alexandria, VA 22310-2553
Phone
(703) 924-2370
Fax
(703) 924-2374
NPI assigned
Oct 25, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Puran S Khalsa, PSYD
Title
Licensed Psychologist
Phone
(415) 235-9982

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 0810004653 VA Primary

Addresses

Primary practice location

6177 Grovedale CT Ste 100
Alexandria, VA 22310-2553

Mailing address

6177 Grovedale CT Ste 100
Alexandria, VA 22310-2553
Phone (703) 924-2370

National Provider Directory

National Provider Directory

Locations

6177 Grovedale Ct
#100
Alexandria, VA 22310
Phone (703) 924-2370

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1902159122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6177 GROVEDALE CT STE 100",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223102553",
            "telephone_number": "703-924-2370",
            "fax_number": "703-924-2374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6177 GROVEDALE CT STE 100",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223102553",
            "telephone_number": "703-924-2370",
            "fax_number": "703-924-2374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN PSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "KHALSA",
        "authorized_official_first_name": "PURAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "415-235-9982",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "VA",
            "license": "0810004653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.