Healthcare Provider Details

I. General information

NPI: 1740733815
Provider Name (Legal Business Name): NICHOLAS RYAN SCHNEIDER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 SW HIGHLAND AVE 3
REDMOND OR
97756-2558
US

IV. Provider business mailing address

20611 DAISY LN
BEND OR
97702-2877
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-2654
  • Fax:
Mailing address:
  • Phone: 515-974-9547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5041
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: