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

Mr. Justin I. Hersom, LCSW

Individual provider Clinical Social Worker · NPI 1871937078

Mr. Justin I. Hersom, LCSW is a Clinical Social Worker in Tillamook, Oregon. Qualified in 2011, 15 years ago. Works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Oregon and Texas.

Years since qualifying
15
Licensed in
OR, TX
In the registry since
2013
Specialties on file
3
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

17250 Wilson River Hwy
Tillamook, OR 97141-9145
Phone: (832) 326-8552
Fax: (503) 842-5035
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1301 S Capital Of Texas Hwy, West Lake Hills, TX 78746-6574 — (737) 477-9457

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 6051 (OR)
Clinical Social Worker Taxonomy 1041C0700X · Licence 55202 (TX)
Social Worker Taxonomy 104100000X · Licence 55202 (TX)

Record details

NPI number1871937078
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorNo
NPI enumeratedApril 18, 2013
Last updated in NPPESJuly 12, 2022
Certification dateJune 17, 2022

Medicare enrollment

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

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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