Provider Demographics
NPI:1891121414
Name:SCHAEFER-LIMBACH, NICHOLSON ERIN (BA, CADC 1, QMHA)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLSON
Middle Name:ERIN
Last Name:SCHAEFER-LIMBACH
Suffix:
Gender:F
Credentials:BA, CADC 1, QMHA
Other - Prefix:MS
Other - First Name:NICCI
Other - Middle Name:ERIN
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA, QMHA
Mailing Address - Street 1:10 SHELTON MCMURPHEY BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4928
Mailing Address - Country:US
Mailing Address - Phone:541-485-2711
Mailing Address - Fax:888-975-0250
Practice Address - Street 1:10 SHELTON MCMURPHEY BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4928
Practice Address - Country:US
Practice Address - Phone:541-485-2711
Practice Address - Fax:888-975-0250
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR17-01-19101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500662328Medicaid
OR500720155Medicaid