1962800797 NPI number — HEIDI C. SCHELLING, PHD, LICSW, PSYCHOTHERAPY SERVICES, LLC

Table of content: (NPI 1962800797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962800797 NPI number — HEIDI C. SCHELLING, PHD, LICSW, PSYCHOTHERAPY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEIDI C. SCHELLING, PHD, LICSW, PSYCHOTHERAPY SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEIDI C SCHELLING PHD LICSW
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962800797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 WILLAMETTE ST.
Provider Second Line Business Mailing Address:
SUITE 307D
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-224-4000
Provider Business Mailing Address Fax Number:
651-756-8151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
541 WILLAMETTE ST
Provider Second Line Business Practice Location Address:
SUITE # 307D
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-224-4000
Provider Business Practice Location Address Fax Number:
651-756-8151
Provider Enumeration Date:
12/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SCHELLING
Authorized Official First Name:
HEIDI
Authorized Official Middle Name:
CHRISTINE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
612-224-4000

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW6117 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 23167 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 19949 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1427095215 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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