ETHAN DAVID PETTYJOHN LPC
NPI 1619452307
Counselor - Professional in Portland, OR
About Ethan David Pettyjohn Lpc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ETHAN DAVID PETTYJOHN LPC (NPI 1619452307) is an individual professional provider in Portland, Oregon, licensed in Oregon (C7752) and active in the NPI registry since September 2018. He is enrolled in Medicare PECOS and is a graduate of Other (2018).
NPPES Registry Identity
Specialties & Licenses
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 David Pettyjohn Lpc 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.
Other Providers at the Same Location NPPES 8
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
PORTLAND, OR 97225
PORTLAND, OR 97225
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 Pettyjohn's NPI number?
The NPI number for Ethan Pettyjohn is 1619452307. It was assigned to this individual provider in the NPPES registry on September 27, 2018.
Where is Ethan Pettyjohn located?
Ethan Pettyjohn practices at 9755 SW Barnes Rd, Portland, OR 97225. The listed phone number is (503) 444-4862.
What is Ethan Pettyjohn's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Ethan Pettyjohn enrolled in Medicare?
Yes. Ethan Pettyjohn 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 Pettyjohn accept?
Health plans from BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc., Providence Health Plan and Regence BlueCross BlueShield of Oregon list Ethan Pettyjohn 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 Pettyjohn was last updated on November 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Ethan David Pettyjohn, LPC · NPI 1619452307
Professional provider in Portland, Oregon. Individual provider, active in the CMS NPPES registry since September 27, 2018.
## Identity
- **NPI:** 1619452307 (Entity type: Individual)
- **Enumerated:** September 27, 2018
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** C7752 (Oregon)
- **Sole proprietor:** No
## Practice location
- **Address:** 9755 SW BARNES RD, Portland, OR 97225-6651
- **Phone:** (503) 444-4862
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Medical school:** Other, class of 2018
## Record status
- **NPPES last updated:** November 13, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1619452307) · Data from the CMS NPPES public registry.