Provider Demographics
NPI:1245095066
Name:ENGLE-TAYLOR, KRISTA (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:
Last Name:ENGLE-TAYLOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:ENGLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:16111 PLUMMER ST BLDG 10
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2036
Mailing Address - Country:US
Mailing Address - Phone:818-891-7711
Mailing Address - Fax:
Practice Address - Street 1:16111 PLUMMER ST BLDG 10
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-2036
Practice Address - Country:US
Practice Address - Phone:818-891-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34674103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist