DR. MARISSA OHLSTROM (PSYD) – Psychologist, NPI 1043775737

DR. MARISSA OHLSTROM (PSYD) is a healthcare provider. based in Beaverton, Oregon. specializing in Psychologist. They hold the professional credentials PSYD. They hold a License No. PY60894649 (WA). The NPI Number for DR. MARISSA OHLSTROM (PSYD) is 1043775737

Main info

Female
8 Years Of Experience
Accepts Medicare Assignment
Name
DR. MARISSA OHLSTROM (PSYD)
NPI
1043775737
Phone
(503) 352-8642
Address
PO BOX 6149
Enumeration Date
6 February 2019
Last Update Date
26 October 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5034721338
Graduation Year
2018 (8 years ago)
PAC ID
6608293899
Group Practice PAC ID
7113823881
Professional Enrollment ID
I20200902002500
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience48
Completeness75
Years active:7State licenses:1Digital endpointsOther names

Provider Addresses for DR. MARISSA OHLSTROM (PSYD)

  • PO BOX 6149

    BEAVERTON, OR 970070149

    Phone: (503) 352-8642

    Fax: (503) 352-8658

    Type: Mailing

  • 3518 FREMONT AVE N # 325

    SEATTLE, WA 981038814

    Phone: (206) 531-4548

    Type: Mailing

  • 4860 RAINIER AVENUE S STE C

    SEATTLE, WA 98118

    Phone: (206) 531-4548

    Type: Location

  • Virginia Garcia Cornelius Wellness Center, 1151, North Adair Street, Cornelius, Metro, Washington County, Oregon, 97113, United States

    CORNELIUS, OR 971138900

    Phone: (503) 359-5564

    Fax: (503) 357-4371

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2020-09-02

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20200902002500IClinical PsychologistWATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 97007)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7113823881View full group profile
NameSpecialtyState
Physician AssistantOR
Nurse PractitionerOR
Emergency Medicine, Family PracticeOR
Family PracticeOR
Physician AssistantOR
Physician AssistantOR
Mental Health CounselorTX
Physician AssistantOR
Family PracticeOR
Internal MedicineOR

Reviews

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Frequently asked questions

Does DR. MARISSA OHLSTROM (PSYD) share an NPI with anyone else?
NPI numbers are unique to each provider or organization — DR. MARISSA OHLSTROM (PSYD) uses 1043775737.
Does the file indicate DR. MARISSA OHLSTROM (PSYD) is practicing under active NPI?
Directory data currently reports DR. MARISSA OHLSTROM (PSYD) as active.
What is DR. MARISSA OHLSTROM (PSYD)'s primary classification?
Psychologist is the headline specialty for DR. MARISSA OHLSTROM (PSYD) here. Clinical services aligned with this taxonomy classification.
Where is DR. MARISSA OHLSTROM (PSYD) based?
DR. MARISSA OHLSTROM (PSYD) is tied to Beaverton, Oregon in the data we show; additional addresses may exist on the full record.
How many locations tie to this NPI?
4 practice locations appear in the available data.

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