Provider Demographics
NPI:1093075996
Name:BEVANS, LISA (LPC,LMHC,NCC,CADCI)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:BEVANS
Suffix:
Gender:F
Credentials:LPC,LMHC,NCC,CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 NE ALOCLEK DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7135
Mailing Address - Country:US
Mailing Address - Phone:503-403-4072
Mailing Address - Fax:
Practice Address - Street 1:3175 NE ALOCLEK DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7135
Practice Address - Country:US
Practice Address - Phone:503-403-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OR15-10-04101YA0400X
WALH60737045101YP2500X
ORC3905101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1093075996Medicaid