Tara Ericksen, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

202105081 Issued in OR

Practice address

4224 NE Halsey St Ste 335
Portland, OR 97213-1568

Phone

(503) 922-6616

NPI assigned

Jan 8, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA, OR2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Western Psychological and Counseling Services LLCGroup PAC ID 7719975085, 331 clinicians

Ocean Psychiatry IncGroup PAC ID 6305277633, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.taraericksen@148835.advancedmd-direct.com
• Direct secure messaging: tericksen288951@direct.ochin.org

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.

• Ocean Psychiatry Inc

  • Psychiatry Physician
  • Fremont, CA
  • NPI 1396306338
  Medicare reassignment Care Compare group NPD
• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Tacoma, WA
  • NPI 1912008178

  OR

  Medicare reassignment Care Compare group NPD
• Axis Community Health Inc

  • Federally Qualified Health Center (FQHC)
  • Pleasanton, CA
  • NPI 1376760546
  Medicare reassignment NPD
• Axis Community Health Inc

  • Federally Qualified Health Center (FQHC)
  • Livermore, CA
  • NPI 1336990506
  NPD
• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Vancouver, WA
  • NPI 1629345731
  NPD
• Ocean Psychological Services, Inc.

  • Behavior Analyst
  • Fremont, CA
  • NPI 1932865029
  NPD (past)

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

{
    "created_epoch": "1546905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713398400000",
    "number": "1780157115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6944 SE STARK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972152153",
            "telephone_number": "503-997-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4224 NE HALSEY ST STE 335",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972131568",
            "telephone_number": "503-922-6616"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "920 Happy Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Pleasanton",
            "state": "CA",
            "postal_code": "945669742",
            "country_code": "US",
            "telephone_number": "925-404-9327",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "52 Dore St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941033828",
            "country_code": "US",
            "telephone_number": "415-553-3100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5925 W Las Positas Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Pleasanton",
            "state": "CA",
            "postal_code": "945888537",
            "country_code": "US",
            "telephone_number": "925-462-1755",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ERICKSEN",
        "first_name": "TARA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-08",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "202105081",
            "primary": true
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CA",
            "license": "NP95010525",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER AND FURNISHING LICENSE",
            "identifier": "NP95010525",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER LICENSE",
            "identifier": "202105081",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eric N. Kim, DDS, PC
• Erica Robyn Burley Mstom Lac
• Erich Lieberknecht LLC
• Cameron J Ericksen
• Michael Kent Ericksen, M.D.
• April Erickson, CRM, QMHA-R
• Arah Erickson, LPC
• Audra Erickson, BS, LMT
• Beth Leanne Erickson, M.S.W
• Christine Joy Erickson, RN, APNP

• Psychiatric/Mental Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; 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.
• 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.