NPIMap

Organization Active NPI

Larsen Sanchez Psychology, LLC

Doing business as Portland Mental Health & Wellness

  • Clinical Psychologist
  • Portland, OR
National Provider Identifier
1588041388
Registry record updated Nov 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
LARSEN SANCHEZ PSYCHOLOGY, LLC
Doing business as
Portland Mental Health & Wellness
Practice address
905 SE 14TH Ave
Portland, OR 97214-2569
Phone
(503) 622-8964
NPI assigned
Apr 30, 2015
Last updated
Nov 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2023

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

Authorized official

Name
Dr. Brad Larsen, PSYDNPI 1679723845
Title
Psychologist/Owner
Phone
(503) 715-5468

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU
Clinical Psychologist 103TC0700X NU Primary
Psychiatric/Mental Health Registered Nurse 163WP0808X NU

Addresses

Primary practice location

905 SE 14TH Ave
Portland, OR 97214-2569

Mailing address

905 SE 14TH Ave
Portland, OR 97214-2569
Phone (503) 715-5468

Other practice location 1

3050 SE Division St Ste 215
Portland, OR 97202-1451
Phone (503) 715-5468

Other practice location 2

812 SW Washington St Ste 700
Portland, OR 97205-3200
Phone (503) 622-8964

Other names 1

  • Portland Mental Health & Wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180315002490 OR Part B Supplier - Clinic/Group Practice 6608138383 Receives reassigned benefits from 58 practitioners
Practice locations: Portland, OR; Salem, OR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2140159Portland Mental Health & Wellness905 SE 14TH Ave, Portland, OR 97214Certificate of waiverNov 14, 2027

National Provider Directory

National Provider Directory

Locations

1717 NE 42nd Ave
Portland, OR 97213
Phone (503) 622-8964

3050 SE Division St
Ste 215
Portland, OR 97202
Phone (503) 622-8964

812 SW Washington St
Ste 700
Portland, OR 97205
Phone (503) 622-8964

905 SE 14th Ave
Portland, OR 97214
Phone (503) 622-8964

Practitioners & affiliated clinicians

Practitioners 159

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 159

NPI Registry JSON

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

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699142400000",
    "number": "1588041388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 SE 14TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142569",
            "telephone_number": "503-715-5468",
            "fax_number": "503-715-5469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 SE 14TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142569",
            "telephone_number": "503-622-8964"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3050 SE Division St Ste 215",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972021451",
            "country_code": "US",
            "telephone_number": "503-715-5468",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "812 SW Washington St Ste 700",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972053200",
            "country_code": "US",
            "telephone_number": "503-622-8964",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LARSEN SANCHEZ PSYCHOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-30",
        "last_updated": "2023-11-05",
        "certification_date": "2023-11-05",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "503-715-5468",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Portland Mental Health & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.