Basic Information
Provider Information
NPI: 1003013053
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ENGEL
FirstName: KRISTIE
MiddleName: DAWN
NamePrefix: DR.
NameSuffix:  
Credential: PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MADDEN
OtherFirstName: KRISTIE
OtherMiddleName: ENGEL
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: PHD
OtherLastNameType: 5
Mailing Information
Address1: PO BOX 2135
Address2:  
City: CEDAR PARK
State: TX
PostalCode: 786302135
CountryCode: US
TelephoneNumber: 5125724673
FaxNumber: 5123556737
Practice Location
Address1: 11701 BEE CAVES RD STE 213
Address2:  
City: AUSTIN
State: TX
PostalCode: 787386468
CountryCode: US
TelephoneNumber: 5125724673
FaxNumber: 5123556737
Other Information
ProviderEnumerationDate: 07/02/2007
LastUpdateDate: 01/03/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/03/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X33629TXY Behavioral Health & Social Service ProvidersPsychologistClinical
103TC2200X33629TXN Behavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
103TP2701X33629TXN Behavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy

ID Information
IDTypeStateIssuerDescription
100301305305TX MEDICAID
3362901TXTX STATE BOARD OF EXAMINERS OF PSYCHOLOGISTSOTHER


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