Evan Tullis Anderson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-42535 Issued in ID

Practice address

300 S 23Rd St
Boise, ID 83702-9100

Phone

(208) 344-3512

Fax

(208) 466-5359

NPI assigned

Jun 29, 2017

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

Enrolled in ID

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lifeways, Inc

  • Community/Behavioral Health Agency
  • Ontario, OR
  • NPI 1568558955

  ID

  Medicare reassignment NPD
• Lifeways, Inc

  • Psychiatric Residential Treatment Facility
  • Hermiston, OR
  • NPI 1144761784
  NPD
• Dr Wall & Associates, LLC

  • Clinical Social Worker
  • Meridian, ID
  • NPI 1154952901
  NPD (past)
• Lifeways, Inc

  • Psychiatric Hospital
  • Boise, ID
  • NPI 1437620358
  NPD (past)

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

{
    "created_epoch": "1498694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781136000000",
    "number": "1780105767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836530009",
            "telephone_number": "208-467-4431",
            "fax_number": "208-467-7684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S 23RD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837029100",
            "telephone_number": "208-344-3512",
            "fax_number": "208-466-5359"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2216 W Fairview Ave",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837026844",
            "country_code": "US",
            "telephone_number": "208-721-5070",
            "fax_number": "208-466-5359",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2825 S Meridian Rd Ste 150",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836427960",
            "country_code": "US",
            "telephone_number": "208-297-9495",
            "fax_number": "208-955-2490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "EVAN",
        "middle_name": "TULLIS",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-29",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-42535",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "34856",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dara Anderson, NP-C
• David Kevin Anderson, M.D.
• Dusti Anderson, BSN RN
• Elizabeth Anne Anderson, RDN
• Emma Dawn Anderson, LMSW
• Geff D Anderson, DC
• Jaiden Anderson
• Jennifer S Anderson, MD
• Jessica Anderson, RN
• Jessica L Anderson, RN

• Clinical Social Worker in Boise, ID
• Providers in Boise, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.