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

Ethan Waranch, PSYD

Individual provider Psychologist · NPI 1053764886

Ethan Waranch, PSYD is a Clinical Psychologist in Portland, Oregon. Qualified in 2021, 5 years ago. Practices with Psychological Services Connection LLC, a 15-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Oregon.

Years since qualifying
5
Licensed in
OR
In the registry since
2016
What do these letters mean?
PSYD — Doctor of Psychology
A doctoral psychologist trained primarily for clinical practice.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

12636 SE Stark St Bldg J
Portland, OR 97233-1058
Phone: (503) 253-4600
Fax: (503) 253-4605
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychologist (primary) Taxonomy 103T00000X · Licence 3654 (OR)

Record details

NPI number1053764886
Entity typeIndividual (Type 1)
GenderMale
Credentials PSYD
Sole proprietorYes
NPI enumeratedJuly 16, 2016
Last updated in NPPESFebruary 2, 2023
Certification dateFebruary 2, 2023
Mailing address1411 Sw Morrison St, Suite 310, Portland, OR 97205-1945

Medicare enrollment

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

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Psychological Services Connection Llc — 15 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Portland