Gracen Tichelaar

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

R7856 Issued in OR

Practice address

2236 SE Belmont St
Portland, OR 97214-2817

Phone

(503) 445-7699

NPI assigned

Dec 13, 2016

Last updated

Mar 9, 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 4

Addresses

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Multnomah County

  dba Multnomah County Health Dept, North Portland

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
  • NPI 1609914787
  Medicare reassignment NPD
• Multnomah County

  dba Multnomah County Health Department, Rockwood

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
  • NPI 1912226325
  NPD
• Multnomah County

  • Federally Qualified Health Center (FQHC)
  • Gresham, OR
  • NPI 1912322074
  NPD
• Cascade AIDS Project

  dba Prism Health Belmont

  • Primary Care Clinic/Center
  • Portland, OR
  • NPI 1275076168
  NPD (past)
• Cascade AIDS Project

  dba Prism Health Morris

  • Primary Care Clinic/Center
  • Portland, OR
  • NPI 1336902394
  NPD (past)
• Connective Therapy Collective

  • Clinical Social Worker
  • Portland, OR
  • NPI 1114561735
  NPD (past)

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

{
    "created_epoch": "1481587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1881138618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 SE LAFAYETTE ST STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972023802",
            "telephone_number": "503-369-9756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2236 SE BELMONT ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142817",
            "telephone_number": "503-445-7699"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1219 SE Lafayette St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972023802",
            "country_code": "US",
            "telephone_number": "503-369-9756",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "847 NE 19th Ave",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972322684",
            "country_code": "US",
            "telephone_number": "503-238-0796",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14600 NW Cornell Rd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972295442",
            "country_code": "US",
            "telephone_number": "503-645-3581",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5415 SW Westgate Dr",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972212409",
            "country_code": "US",
            "telephone_number": "503-369-9756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TICHELAAR",
        "first_name": "GRACEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-13",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "R7856",
            "primary": true
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yen Tibayan, M.D.
• Robin Lynn Tibbals, LMT
• Alheli Tica-Figueroa, MA
• Brittney Tice, RN BSN
• Emma Louise Tice
• Dana Ticker, B.A.
• Suzanne Gail Tiddy, LCSW
• Cathy Jean Tidland
• Brandy Lee Tidwell, PHD
• Justin Alan Tidwell, DPM

• 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 Mar 9, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.