Provider Demographics
NPI:1811172026
Name:ENGEBRETSON PSYCHOLOGY, LLC
Entity type:Organization
Organization Name:ENGEBRETSON PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TILMER
Authorized Official - Middle Name:O
Authorized Official - Last Name:ENGEBRETSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:571-633-0600
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003165103TB0200X, 103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty