Dr Katie Evans Inc

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CP00004591 Issued in WA

Legal business name

DR KATIE EVANS INC

Practice address

19943 SW Jette LN
Beaverton, OR 97006-2789

Phone

(503) 756-6117

Fax

(503) 524-3778

NPI assigned

Feb 25, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Katie Evans Kelley, PHD, CDP, RC, NCACII

Title

Treatment Director Ceo

Phone

(503) 756-6117

Specialties & licenses 2

Addresses

Other identifiers 6

Other names 1

• EVANS & SULLIVAN Former legal business name

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

{
    "created_epoch": "1203897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317945600000",
    "number": "1255500203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19943 SW JETTE LN",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970062789",
            "telephone_number": "503-756-6117",
            "fax_number": "503-524-3778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19943 SW JETTE LN",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970062789",
            "telephone_number": "503-756-6117",
            "fax_number": "503-524-3778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR KATIE EVANS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-25",
        "last_updated": "2011-10-07",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "EVANS",
        "authorized_official_title_or_position": "TREATMENT DIRECTOR CEO",
        "authorized_official_telephone_number": "503-756-6117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, CDP, RC, NCACII"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "860106",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "WA",
            "license": "CP00004591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PBH",
            "identifier": "1615-01",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "100000012349",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN SERVICES",
            "identifier": "0001152747",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "283365",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIFEWISE",
            "identifier": "669401100000",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUECROSS BLUESHIELD OF OREGON",
            "identifier": "3006890",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EVANS & SULLIVAN",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Professional Counselor in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2011; 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.