Provider Demographics
NPI:1366771172
Name:SCHAFFNER, GERALD LLOYD (MAMFT, LMFT)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:LLOYD
Last Name:SCHAFFNER
Suffix:
Gender:M
Credentials:MAMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 82819
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97282-0819
Mailing Address - Country:US
Mailing Address - Phone:503-233-5405
Mailing Address - Fax:503-233-2694
Practice Address - Street 1:21210 NW MAUZEY RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9327
Practice Address - Country:US
Practice Address - Phone:503-439-9531
Practice Address - Fax:503-531-3841
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTO494106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WDBCHOtherMEDICARE GROUP
OR164936Medicaid