Provider Demographics
NPI:1851644439
Name:KARAKASHIAN, TODD KENNETH (PMHNP)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:KENNETH
Last Name:KARAKASHIAN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 NW 21ST AVE
Mailing Address - Street 2:STE. 104
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1513
Mailing Address - Country:US
Mailing Address - Phone:503-850-9123
Mailing Address - Fax:503-210-1414
Practice Address - Street 1:1133 NW 21ST AVE STE 104
Practice Address - Street 2:STE. 104
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1513
Practice Address - Country:US
Practice Address - Phone:503-406-2727
Practice Address - Fax:503-974-2000
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-20
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60299917363LP0808X
OR201250157NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022959Medicaid
R0000WCJHTMedicare Oscar/Certification