ETHAN WARANCH PSYD
NPI 1053764886
Psychologist in Portland, OR

Active since July 16, 2016PECOS EnrolledAccepts Medicare Assignment
12636 SE STARK ST BLDG J, PORTLAND, OR 97233(503) 253-4600(503) 253-4605 Get Directions Write a Review

NPPES record last updated: February 2, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 2, 2023, Jul 16, 2016 (2 updates tracked since 2016).

About Ethan Waranch Psyd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ETHAN WARANCH PSYD (NPI 1053764886) is an individual psychologist in Portland, Oregon, licensed in Oregon (3654) and active in the NPI registry since July 2016. He is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1053764886
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameETHAN WARANCHCredential: PSYD
Location Address12636 SE STARK ST BLDG JPortland, OR 97233-1058
Mailing Address1411 Sw Morrison St, Suite 310Portland, OR 97205-1945 · (503) 352-2400 · Fax (503) 352-2403
Fax(503) 253-4605
Sole ProprietorYes
Medical School CMSOtherGraduated 2021
Enumeration DateJuly 16, 2016
Last NPPES UpdateFebruary 2, 20232 updates tracked since enumeration
NPPES CertifiedFebruary 2, 2023
NPI 1053764886 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in OR · 3654
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
12636 SE STARK ST BLDG J, Portland, OR 97233

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Ethan Waranch Psyd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2961861273
PECOS Enrollment IDI20230705002505
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Psychotherapy, 45 minutes 90834
Psychotherapy is a treatment method where you converse with a therapist about your thoughts, feelings, and behaviors. In a 45-minute session, the therapist assists you in understanding and managing your mental health concerns, improving emotional wellness, and promoting personal growth.
51 services14 patients

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Counselor (Professional)
12636 SE STARK ST BLDG J
PORTLAND, OR 97233
Counselor
12636 SE STARK ST BLDG J
PORTLAND, OR 97233
Counselor (Professional)
12636 SE STARK ST BLDG J
PORTLAND, OR 97233
Counselor (Mental Health)
12636 SE STARK ST BLDG J
PORTLAND, OR 97233
Psychiatry & Neurology (Psychiatry)
12636 SE STARK ST BLDG J
PORTLAND, OR 97233
Counselor (Mental Health)
12636 SE STARK ST BLDG J
PORTLAND, OR 97233
Counselor (Professional)
12636 SE STARK ST BLDG J
PORTLAND, OR 97233
Psychologist (Clinical)
12636 SE STARK ST BLDG J
PORTLAND, OR 97233

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethan Waranch's NPI number?

The NPI number for Ethan Waranch is 1053764886. It was assigned to this individual provider in the NPPES registry on July 16, 2016.

Where is Ethan Waranch located?

Ethan Waranch practices at 12636 SE Stark St Bldg J, Portland, OR 97233. The listed phone number is (503) 253-4600.

What is Ethan Waranch's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Ethan Waranch enrolled in Medicare?

Yes. Ethan Waranch is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Ethan Waranch accept?

Health plans from BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc., PacificSource Health Plans and Providence Health Plan and 1 other insurer list Ethan Waranch as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ethan Waranch was last updated on February 2, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.