Healthcare Provider Details

I. General information

NPI: 1740847227
Provider Name (Legal Business Name): CHEYENNE NIEBLAS-HERRERA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62930 OB RILEY RD STE 200
BEND OR
97703-9459
US

IV. Provider business mailing address

399 E 10TH AVE
EUGENE OR
97401-3380
US

V. Phone/Fax

Practice location:
  • Phone: 541-330-1919
  • Fax:
Mailing address:
  • Phone: 541-868-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-87318
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL11476
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: