Provider Demographics
NPI:1457787939
Name:LOCKARY, EVAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:LOCKARY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 SE RURAL ST APT 202
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5861
Mailing Address - Country:US
Mailing Address - Phone:415-847-0838
Mailing Address - Fax:
Practice Address - Street 1:11010 SE DIVISION ST STE 202
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-6400
Practice Address - Country:US
Practice Address - Phone:503-335-5975
Practice Address - Fax:503-335-5974
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
OR3416103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program