Provider Demographics
NPI:1346346566
Name:SCHAFFER, HOLLY SUZANNE (MA LPC)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:SUZANNE
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 SW HAMPTON ST STE 125
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8361
Mailing Address - Country:US
Mailing Address - Phone:503-550-5089
Mailing Address - Fax:202-908-5389
Practice Address - Street 1:7000 SW HAMPTON ST STE 125
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8361
Practice Address - Country:US
Practice Address - Phone:503-550-5089
Practice Address - Fax:202-908-5389
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC21022101YP2500X
101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500713918Medicaid