Provider Demographics
NPI:1477282796
Name:ENGSTROM-GARNER, KAEGAN (LMFT)
Entity Type:Individual
Prefix:
First Name:KAEGAN
Middle Name:
Last Name:ENGSTROM-GARNER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11325 PARK VISTA BLVD APT 2217
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-7161
Mailing Address - Country:US
Mailing Address - Phone:817-997-4525
Mailing Address - Fax:
Practice Address - Street 1:11325 PARK VISTA BLVD APT 2217
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-7161
Practice Address - Country:US
Practice Address - Phone:817-997-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203731106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty