Provider Demographics
NPI:1194477471
Name:ENGBERG, KRISTIN (LPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ENGBERG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6119 GREENVILLE AVE # 625
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1910
Mailing Address - Country:US
Mailing Address - Phone:214-998-5300
Mailing Address - Fax:
Practice Address - Street 1:4849 GREENVILLE AVE STE 1675
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4153
Practice Address - Country:US
Practice Address - Phone:214-998-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68320101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional