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General NPI Number Information
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NPI Number | 1811172026
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Entity Type | Organization
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Legal Business Name | ENGEBRETSON PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 7927 JONES BRANCH DR SUITE #6125
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City | MC LEAN
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State | VA
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Zip | 22102-3322
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Country | US
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Telephone | 571-633-0600
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Fax | 703-992-0993
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Provider Business Mailing Address
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Address Line | 7927 JONES BRANCH DR SUITE #6125
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City | MC LEAN
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State | VA
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Zip | 22102-3322
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Country | US
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Telephone | 571-633-0600
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Fax | 703-992-0993
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Authorized Official
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Title or Position | OWNER
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Name | DR. TILMER O. ENGEBRETSON
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Credential | PH.D.
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Telephone | 571-633-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 0810003165
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | 0810003165
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810003165
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License Number State | VA
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