Alicia Banister

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C6803 Issued in OR

Practice address

3930 SE Ivon St
Portland, OR 97202-1651

Phone

(503) 893-2067

NPI assigned

Jan 6, 2015

Last updated

Aug 24, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 20, 2024 through May 20, 2028

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cairn Somatic Counseling, LLC

  • Mental Health Counselor
  • Portland, OR
  • NPI 1932017944
  Authorized official Same address or phone

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

{
    "created_epoch": "1420502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1649668138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3930 SE IVON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972021651",
            "telephone_number": "503-893-2067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 SE IVON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972021651",
            "telephone_number": "503-893-2067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANISTER",
        "first_name": "ALICIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-06",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C6803",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "21093",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Sharaf Banger, PMHNP
• Alexandria Bangert, LPC
• Stephanie Bangerter
• Mackenzie Bangs, BCBA
• Sierra Bangs
• Larissa Marie Banitt
• Marianne Munch Banke, L.AC.
• Megan A Banker, D.C.
• Destiny Marie Bankhead, MS, LPSC
• Jennifer Lynne Banko

• Mental Health Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.