Healthcare Provider Details

I. General information

NPI: 1376494690
Provider Name (Legal Business Name): ENRIQUE CHILDRESS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CYPRESS CREEK RD STE 201
CEDAR PARK TX
78613-4468
US

IV. Provider business mailing address

1001 CYPRESS CREEK RD STE 201
CEDAR PARK TX
78613-4468
US

V. Phone/Fax

Practice location:
  • Phone: 512-534-0848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number39745
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number39745
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number39745
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: