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THERON BRADLEY NYSTROM
NPI 1932689510
Counselor - Mental Health in Vancouver, WA

Active since August 14, 2018PECOS Enrolled
1014 MAIN ST, VANCOUVER, WA 98660(360) 695-1014 Get Directions Write a Review

NPPES record last updated: August 14, 2018. Verified against the NPPES registry weekly; last sync: November 08, 2026.

About Theron Bradley Nystrom NPPES

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

THERON BRADLEY NYSTROM (NPI 1932689510) is an individual mental health provider in Vancouver, Washington, licensed in Washington (CG60883880) and active in the NPI registry since August 2018. He is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1932689510
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameTHERON BRADLEY NYSTROM
Location Address1014 MAIN STVancouver, WA 98660-3151
Mailing Address1014 Main StVancouver, WA 98660-3151 · (360) 695-1014
Phone(360) 695-1014
Sole ProprietorYes
Medical School CMSOtherGraduated 2018
Enumeration DateAugust 14, 2018
✔ NPI 1932689510 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in WA · CG60883880
1014 MAIN ST, Vancouver, WA 98660
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Theron Bradley Nystrom is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4082179569
PECOS Enrollment IDI20260724002863
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.

Medicare Billing Reassignment

Medicare enrollment records show Theron Nystrom reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Open Mind Mental Health Physicians, Inc.
927 mi
Clinical
3252 HOLIDAY CT STE 204
La Jolla, CA 92037
  • Reassigned Medicare billing, Washington enrollment
  • 4 clinicians in this Medicare group
NPI 1093454423 (855) 550-6463

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

TRACI DOWNER
Counselor (Mental Health)
1014 MAIN ST
VANCOUVER, WA 98660
Clark County (360) 695-1014
CAITLIN WALTHER
Counselor (Mental Health)
1014 MAIN ST
VANCOUVER, WA 98660
Clark County (360) 695-1014
ASHLEY N STROH
Counselor (Mental Health)
1014 MAIN ST
VANCOUVER, WA 98660
Clark County (360) 695-1014
ALEXA EDWARDS
Counselor (Mental Health)
1014 MAIN ST
VANCOUVER, WA 98660
Clark County (360) 695-1014
STEPHANIE AMATO
Counselor (Mental Health)
1014 MAIN ST
VANCOUVER, WA 98660
Clark County (360) 695-1014
PAIGE GEHRKE
Counselor
1014 MAIN ST
VANCOUVER, WA 98660
Clark County (360) 695-1014
ANDEE GLEASON
Counselor (Mental Health)
1014 MAIN ST
VANCOUVER, WA 98660
Clark County (360) 695-1014
TAMMY BEDLION
Counselor
1014 MAIN ST
VANCOUVER, WA 98660
Clark County (360) 695-1014

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 Theron Nystrom's NPI number?

The NPI number for Theron Nystrom is 1932689510. It was assigned to this individual provider in the NPPES registry on August 14, 2018.

Where is Theron Nystrom located?

Theron Nystrom practices at 1014 Main St, Vancouver, WA 98660. The listed phone number is (360) 695-1014.

What is Theron Nystrom's specialty?

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

Is Theron Nystrom enrolled in Medicare?

Yes. Theron Nystrom is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Theron Nystrom's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Theron Nystrom reassigns Medicare benefits to Open Mind Mental Health Physicians, Inc. (La Jolla, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Theron Nystrom's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Theron Nystrom was last updated on August 14, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.