Active NPI
Clarence Wayne Yocky, PH.D.
- Clinical Psychologist
- Beaverton, OR
National Provider Identifier
1629167218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0861
- Practice address
- 9670 SW Beaverton Hillsdale Hwy
Beaverton, OR 97005-3307 - Phone
- (503) 626-9494
- Fax
- (503) 646-8401
- NPI assigned
- Oct 12, 2006
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0861 | OR | Primary |
Addresses
Primary practice location
9670 SW Beaverton Hillsdale Hwy
Beaverton, OR 97005-3307
Mailing address
9670 SW Beaverton Hillsdale Hwy
Beaverton, OR 97005-3307
Phone (503) 626-9494
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 076732 | Medicaid | OR |
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 |
|---|---|---|---|
| 0861 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1629167218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9670 SW BEAVERTON HILLSDALE HWY",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970053307",
"telephone_number": "503-626-9494",
"fax_number": "503-646-8401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9670 SW BEAVERTON HILLSDALE HWY",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970053307",
"telephone_number": "503-626-9494",
"fax_number": "503-646-8401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOCKY",
"first_name": "CLARENCE",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "0861",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "076732",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.