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

Mr. Mitchell Tyler Bacon

Individual provider Marriage & Family Therapist · NPI 1083967442

Mr. Mitchell Tyler Bacon is a Marriage and Family Therapist in Portland, Oregon. Qualified in 2013, 13 years ago. Practices with Kaiser Foundation Health Plan of the Northwest, a 1,811-clinician group and accepts Medicare assignment. Licensed in Oregon and Washington.

Years since qualifying
13
Licensed in
OR, WA
In the registry since
2012
Specialties on file
2
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Practice location Address checks out

3550 N Interstate Ave
Portland, OR 97227-1196
Phone: (800) 813-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Marriage & Family Therapist (primary) Taxonomy 106H00000X · Licence T1282 (OR)
Marriage & Family Therapist Taxonomy 106H00000X · Licence LF60724149 (WA)

Record details

NPI number1083967442
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedOctober 23, 2012
Last updated in NPPESDecember 21, 2021
Certification dateDecember 21, 2021

Medicare enrollment

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

Medicare specialtyMARRIAGE AND FAMILY THERAPIST
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Kaiser Foundation Health Plan Of The Northwest — 1811 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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