Provider Demographics
NPI:1962800797
Name:HEIDI C. SCHELLING, PHD, LICSW, PSYCHOTHERAPY SERVICES, LLC
Entity type:Organization
Organization Name:HEIDI C. SCHELLING, PHD, LICSW, PSYCHOTHERAPY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:SCHELLING
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:612-224-4000
Mailing Address - Street 1:251 WILLAMETTE ST.
Mailing Address - Street 2:SUITE 307D
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:612-224-4000
Mailing Address - Fax:651-756-8151
Practice Address - Street 1:541 WILLAMETTE ST
Practice Address - Street 2:SUITE # 307D
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:612-224-4000
Practice Address - Fax:651-756-8151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLCSW61171041C0700X
MN231671041C0700X
CA199491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427095215OtherNPI