Provider Demographics
NPI:1003013053
Name:ENGEL, KRISTIE DAWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:DAWN
Last Name:ENGEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KRISTIE
Other - Middle Name:ENGEL
Other - Last Name:MADDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 2135
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78630-2135
Mailing Address - Country:US
Mailing Address - Phone:512-572-4673
Mailing Address - Fax:512-355-6737
Practice Address - Street 1:11701 BEE CAVES RD STE 213
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6468
Practice Address - Country:US
Practice Address - Phone:512-572-4673
Practice Address - Fax:512-355-6737
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33629103TP2701X, 103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1003013053Medicaid
TX33629OtherTX STATE BOARD OF EXAMINERS OF PSYCHOLOGISTS