MEDICARE: DR. KRISTIE DAWN ENGEL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TP2701X	Group Psychotherapy Psychologist	33629	TX
2	103TC2200X	Clinical Child & Adolescent Psychologist	33629	TX
3	103TC0700X	Clinical Psychologist	33629	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	33629	OTHER	TX	TX STATE BOARD OF EXAMINERS OF PSYCHOLOGISTS

General Provider Information

NPI Number	:	1003013053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIE DAWN ENGEL PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 2135
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78630-2135
Country	:	US
Telephone Number	:	512-572-4673
Fax Number	:	512-355-6737

Provider Business Practice Location Address
First Line	:	11701 BEE CAVES RD STE 213
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78738-6468
Country	:	US
Telephone Number	:	512-572-4673
Fax Number	:	512-355-6737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	11/02/2020

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