Lusijah Marx, PSYD, PMHNP, RN

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

964 Issued in OR

Practice address

2901 E Burnside St
Portland, OR 97214-1831

Phone

(503) 238-5203

Fax

(503) 238-5202

NPI assigned

Feb 13, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Laura Jacobson Former name

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

Specialty

Clinical Psychologist

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Radiance Integrative Health and WellnessGroup PAC ID 3870028715, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy, Registered Nurse

State licenses

Practice roles

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.

• Radiance Integrative Health & Wellness

  • Health Service Clinic/Center
  • Portland, OR
  • NPI 1124863261
  Medicare reassignment Care Compare group NPD
• Redwood Collaborative, LLC

  • Mental Health Counselor
  • Portland, OR
  • NPI 1477252716
  NPD
• Project Quest

  • Specialist
  • Portland, OR
  • NPI 1134458052
  NPD (past)

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1780726976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141831",
            "telephone_number": "503-238-5203",
            "fax_number": "503-238-5202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 E BURNSIDE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141831",
            "telephone_number": "503-238-5203",
            "fax_number": "503-238-5202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARX",
        "first_name": "LUSIJAH",
        "credential": "PSYD, PMHNP, RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-13",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "OR",
            "license": "964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "298940",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "JACOBSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Leandro Rios Marx-Albuquerque, MD
• Adam N Marx
• Alissa Marx
• Benjamin Leo Marx, L.AC.
• Laurie B Marx
• Polonca Marx, LMT
• Kathryn Marxen-Simonson, MSOT, OTR/L
• Mary Ann Penny Domm
• Mary Anne Stowell LCSW, PC
• Mary Frazel ND

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.