Individual provider Active NPI

Evan Lockary, PSY.D

  • Clinical Child & Adolescent Psychologist
  • Portland, OR
National Provider Identifier
1457787939
Registry record updated Jul 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
3416 Issued in OR
Practice address
11010 SE Division St Ste 202
Portland, OR 97266-6400
Phone
(503) 335-5975
Fax
(503) 335-5974
NPI assigned
Sep 17, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Child & Adolescent Psychologist 103TC2200X 3416 OR Primary

Addresses

Primary practice location

11010 SE Division St Ste 202
Portland, OR 97266-6400

Mailing address

1630 SE Rural St Apt 202
Portland, OR 97202-5861
Phone (415) 847-0838

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL wp.options.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210803003895 OR Practitioner - Clinical Psychologist 5799189361 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Options Counseling Services of Oregon Mental Health CurrentSince Jul 12, 2021 Accepting new patients
Inner Room Somatic Therapy, LLC Past Accepting new patients

Locations

360 E 10th Ave
Ste 450
Eugene, OR 97401

11010 SE Division St
Ste 202
Portland, OR 97266
Phone (503) 335-5975

2645 Portland Rd NE
Ste 120
Salem, OR 97301

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1379376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625270400000",
    "number": "1457787939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 SE RURAL ST APT 202",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972025861",
            "telephone_number": "415-847-0838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11010 SE DIVISION ST STE 202",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972666400",
            "telephone_number": "503-335-5975",
            "fax_number": "503-335-5974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOCKARY",
        "first_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-17",
        "last_updated": "2021-07-03",
        "certification_date": "2021-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "OR",
            "license": "3416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "wp.options.org",
            "affiliation": "N",
            "address_1": "3500 Chad Dr Ste 350",
            "city": "Eugene",
            "state": "OR",
            "country_code": "US",
            "postal_code": "974087602",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.