Healthcare Provider Details

I. General information

NPI: 1962800797
Provider Name (Legal Business Name): HEIDI C. SCHELLING, PHD, LICSW, PSYCHOTHERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 WILLAMETTE ST SUITE # 307D
EUGENE OR
97401
US

IV. Provider business mailing address

251 WILLAMETTE ST. SUITE 307D
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 612-224-4000
  • Fax: 651-756-8151
Mailing address:
  • Phone: 612-224-4000
  • Fax: 651-756-8151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23167
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19949
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW6117
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1427095215
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerNPI

VIII. Authorized Official

Name: MS. HEIDI CHRISTINE SCHELLING
Title or Position: OWNER
Credential: PHD, LCSW
Phone: 612-224-4000