NPIMap

Organization Active NPI

Evans Psychological

  • Clinical Psychologist
  • Omaha, NE
National Provider Identifier
1982885968
Registry record updated Nov 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
77 Issued in NE
Legal business name
EVANS PSYCHOLOGICAL
Practice address
12728 Augusta Ave
Ste 150
Omaha, NE 68144-3754
Phone
(402) 330-1537
Fax
(402) 330-9331
NPI assigned
Nov 19, 2007
Last updated
Nov 19, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2007

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

Authorized official

Name
Dr. Timothy C Evans, PHD
Title
Owner
Phone
(402) 330-1537

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 77 NE Primary

Addresses

Primary practice location

12728 Augusta Ave
Ste 150
Omaha, NE 68144-3754

Mailing address

12728 Augusta Ave
Ste 150
Omaha, NE 68144-3754
Phone (402) 330-1537

Other identifiers 1

IdentifierTypeStateIssuer
47078906000MedicaidNE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1195430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1982885968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12728 AUGUSTA AVE",
            "address_2": "STE 150",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681443754",
            "telephone_number": "402-330-1537",
            "fax_number": "402-330-9331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12728 AUGUSTA AVE",
            "address_2": "STE 150",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681443754",
            "telephone_number": "402-330-1537",
            "fax_number": "402-330-9331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANS PSYCHOLOGICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-19",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-330-1537",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NE",
            "license": "77",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47078906000",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.

Verify at the official NPI Registry.