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ALICIA BANISTER
NPI 1649668138
Counselor - Mental Health in Portland, OR

Active since January 06, 2015Opted out of Medicare · through May 20, 2028
3930 SE IVON ST, PORTLAND, OR 97202(503) 893-2067 Get Directions Write a Review

NPPES record last updated: August 24, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 24, 2023, Jul 20, 2023 (2 updates tracked since 2023).

About Alicia Banister NPPES

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

ALICIA BANISTER (NPI 1649668138) is an individual mental health provider in Portland, Oregon, licensed in Oregon (C6803) and active in the NPI registry since January 2015. She has opted out of Medicare through May 20, 2028.

NPPES Registry Identity

NPI1649668138
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameALICIA BANISTER
Location Address3930 SE IVON STPortland, OR 97202-1651
Mailing Address3930 Se Ivon StPortland, OR 97202-1651 · (503) 893-2067
Phone(503) 893-2067
Sole ProprietorNo
Enumeration DateJanuary 6, 2015
Last NPPES UpdateAugust 24, 20232 updates tracked since enumeration
NPPES CertifiedAugust 24, 2023
✔ NPI 1649668138 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in OR · C6803
Also ListedMassage TherapistTaxonomy 225700000X · License 21093 (OR)
3930 SE IVON ST, Portland, OR 97202
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Alicia Banister has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from May 20, 2024 through May 20, 2028.

Opt-Out Effective DateMay 20, 2024
Opt-Out In Effect ThroughMay 20, 2028Opt-out affidavits renew automatically every two years unless cancelled

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 Alicia Banister's NPI number?

The NPI number for Alicia Banister is 1649668138. It was assigned to this individual provider in the NPPES registry on January 6, 2015.

Where is Alicia Banister located?

Alicia Banister practices at 3930 SE Ivon St, Portland, OR 97202. The listed phone number is (503) 893-2067.

What is Alicia Banister's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Alicia Banister enrolled in Medicare?

No. Alicia Banister has opted out of Medicare through May 20, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Alicia Banister was last updated on August 24, 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.