1851644439 NPI number — TODD KENNETH KARAKASHIAN PMHNP

Table of content: TODD KENNETH KARAKASHIAN PMHNP (NPI 1851644439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851644439 NPI number — TODD KENNETH KARAKASHIAN PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARAKASHIAN
Provider First Name:
TODD
Provider Middle Name:
KENNETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851644439
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1133 NW 21ST AVE
Provider Second Line Business Mailing Address:
STE. 104
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97209-1513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-850-9123
Provider Business Mailing Address Fax Number:
503-210-1414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1133 NW 21ST AVE STE 104
Provider Second Line Business Practice Location Address:
STE. 104
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97209-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-406-2727
Provider Business Practice Location Address Fax Number:
503-974-2000
Provider Enumeration Date:
10/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  AP60299917 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 201250157NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 022959 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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