Mark Ira Reck, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3539 Issued in OR

Practice address

812 SW Washington St Ste 700
Portland, OR 97205-3200

Phone

(503) 622-8964

NPI assigned

Apr 13, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Larsen Sanchez Psychology, LLC

  • Clinical Psychologist
  • Portland, OR
  • NPI 1588041388
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1063155513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3178 SW 12TH AVE APT 204",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393144",
            "telephone_number": "503-863-1290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 SW WASHINGTON ST STE 700",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972053200",
            "telephone_number": "503-622-8964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RECK",
        "first_name": "MARK",
        "middle_name": "IRA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-13",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "3539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nastja Rebrin
• Alexander Recalt, PHD, MS, LCSW
• Yvonne Recchia, LCSW
• Receptive Medicine LLC
• Valeria Rech, RD
• Brianna Recklies
• Reconstructed Wellness, LLC
• Recovercare, LLC.
• Recovered Roots Counseling LLC
• Recovery Et Cetera

• Clinical Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.