Justin I. Hersom, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6051 Issued in OR

Practice address

17250 Wilson River Hwy
Tillamook, OR 97141-9145

Phone

(832) 326-8552

Fax

(503) 842-5035

NPI assigned

Apr 18, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in OR, TX2 enrollments

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 2

Specialty

Clinical Social Worker

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Hersom Psychotherapy, PLLC

  • Clinical Social Worker
  • West Lake Hills, TX
  • NPI 1770216335

  OR

  Medicare reassignment NPD Authorized official
• Northwest Medical Foundation of Tillamook

  • Critical Access Hospital
  • Tillamook, OR
  • NPI 1871575225
  Medicare reassignment NPD
• Northwest Medical Foundation of Tillamook

  • Critical Access Hospital
  • Sheridan, OR
  • NPI 1053873919
  NPD
• Northwest Medical Foundation of Tillamook

  • Rural Health Clinic/Center
  • Manzanita, OR
  • NPI 1154699379
  NPD

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

{
    "created_epoch": "1366243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1871937078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17250 WILSON RIVER HWY",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971419145",
            "telephone_number": "832-326-8552",
            "fax_number": "503-842-5035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17250 WILSON RIVER HWY",
            "city": "TILLAMOOK",
            "state": "OR",
            "postal_code": "971419145",
            "telephone_number": "832-326-8552",
            "fax_number": "503-842-5035"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 S Capital Of Texas Hwy",
            "address_purpose": "LOCATION",
            "city": "West Lake Hills",
            "state": "TX",
            "postal_code": "787466574",
            "country_code": "US",
            "telephone_number": "737-477-9457",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERSOM",
        "first_name": "JUSTIN",
        "middle_name": "I.",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-18",
        "last_updated": "2022-07-12",
        "certification_date": "2022-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "55202",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TX",
            "license": "55202",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "6051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anne Louise Heiner
• Alana Rose Hennings
• Barbara Jeanne Herdman, P.N.P.
• Paul J Hernandez
• Robyn L Herrick
• Brett Jess Hestmark, D.M.D.
• Calvin Ray Hill, M.D.
• Hoang Ho
• John Robert Holland, CSWA/QMHP
• Anthony Christopher Huacuja

• Clinical Social Worker in Tillamook, OR
• Providers in Tillamook, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.
• 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.