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Organization

DR KATIE EVANS INC

Active
Other names
EVANS & SULLIVAN
Organization subpart
No

Provider details

NPI number
Authorized official
DR. KATIE EVANS KELLEY PHD, CDP, RC, NCACII (TREATMENT DIRECTOR CEO)
(503) 756-6117
Entity
Organization

Contact information

Practice address
19943 SW JETTE LN, BEAVERTON, OR 97006-2789
(503) 756-6117
(503) 524-3778
Mailing address
19943 SW JETTE LN, BEAVERTON, OR 97006-2789
(503) 756-6117
(503) 524-3778

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
860106
OR
101YP2500X
Professional Counselor
Primary
CP00004591
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0001152747
MHN SERVICES
01
100000012349
REGENCE
OR
01
1615-01
PBH
01
283365
MULTIPLAN
OR
01
3006890
REGENCE BLUECROSS BLUESHIELD OF OREGON
OR
01
669401100000
LIFEWISE
OR
Enumeration date
02/25/2008
Last updated
10/07/2011
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