Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ethan David Pettyjohn, LPC

Individual provider Professional Counselor · NPI 1619452307

Ethan David Pettyjohn, LPC is a Mental Health Counselor in Portland, Oregon. Qualified in 2018, 8 years ago. Practices with Western Psychological and Counseling Services LLC, a 332-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Oregon.

Years since qualifying
8
Licensed in
OR
In the registry since
2018
What do these letters mean?
LPC — Licensed Professional Counselor
A licensed mental health counsellor.

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Practice location Address checks out

9755 SW Barnes Rd
Portland, OR 97225-6651
Phone: (503) 444-4862
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence C7752 (OR)

Record details

NPI number1619452307
Entity typeIndividual (Type 1)
GenderMale
Credentials LPC
Sole proprietorNo
NPI enumeratedSeptember 27, 2018
Last updated in NPPESNovember 13, 2023
Certification dateNovember 13, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Western Psychological And Counseling Services Llc — 332 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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