Roger Evenson, LCSW-44535

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-44535 Issued in ID

Practice address

951 E Plaza Dr Ste 150
Eagle, ID 83616-6567

Phone

(208) 938-2836

NPI assigned

Jun 21, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wellspring Behavioral Health, Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Eagle, ID
  • NPI 1124642293

  Mental Health

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786579200000",
    "number": "1164091559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3076 N FIVE MILE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837135215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 E PLAZA DR STE 150",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166567",
            "telephone_number": "208-938-2836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVENSON",
        "first_name": "ROGER",
        "credential": "LCSW-44535",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-21",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LMSW-40940",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-44535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Craig Ellison, D.C.
• Emp Idaho Nampa, LLC
• Enhanced Aesthetics and Wellness
• Evan Hathaway DDS PA
• Lyndsey Evans
• Evergreen Psychology & Wellness, LLC
• Evolution Chiropractic and Wellness
• Evolution Joint Pain Clinic
• Eye 2 Eye PLLC
• Family & Functional Medicine of Idaho PLLC

• All providers in Eagle, ID
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.