Active NPI
Stephen Lon Okiyama, PH.D.
- Clinical Psychologist
- Loveland, CO
National Provider Identifier
1124162557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY12716
- Practice address
- 305 Knobcone Dr Unit 202
Loveland, CO 80538-5711 - Phone
- (310) 954-7492
- NPI assigned
- Feb 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY12716 | CA | Primary |
| Counseling Psychologist | 103TC1900X | |||
| Psychologist | 103T00000X | PSY12716 | CA |
Addresses
Primary practice location
305 Knobcone Dr Unit 202
Loveland, CO 80538-5711
Mailing address
123 Aylesworth HL NW
Fort Collins, CO 80523-0001
Phone (970) 491-3387
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY127160 | Medicaid | CA | |
| 74310 | Other | CA | MANAGED HEALTH NETWORK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY12716 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352073600000",
"number": "1124162557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 AYLESWORTH HL NW",
"city": "FORT COLLINS",
"state": "CO",
"postal_code": "805230001",
"telephone_number": "970-491-3387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 KNOBCONE DR UNIT 202",
"city": "LOVELAND",
"state": "CO",
"postal_code": "805385711",
"telephone_number": "310-954-7492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OKIYAMA",
"first_name": "STEPHEN",
"middle_name": "LON",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-18",
"last_updated": "2012-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY12716",
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY12716",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY127160",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANAGED HEALTH NETWORK",
"identifier": "74310",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Loveland, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.