Provider Demographics
NPI:1780869149
Name:ENGEBRETSON, TILMER O (PHD)
Entity type:Individual
Prefix:DR
First Name:TILMER
Middle Name:O
Last Name:ENGEBRETSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7927 JONES BRANCH DR
Mailing Address - Street 2:SUITE #6125
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3322
Mailing Address - Country:US
Mailing Address - Phone:571-633-0600
Mailing Address - Fax:703-992-0993
Practice Address - Street 1:7927 JONES BRANCH DR
Practice Address - Street 2:SUITE #6125
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3322
Practice Address - Country:US
Practice Address - Phone:571-633-0600
Practice Address - Fax:703-992-0993
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003165103TC0700X, 103TH0004X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral