Healthcare Provider Details

I. General information

NPI: 1568851459
Provider Name (Legal Business Name): INNER WELLNESS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 NW STOVER
BEND OR
97703
US

IV. Provider business mailing address

2130 NW STOVER
BEND OR
97703
US

V. Phone/Fax

Practice location:
  • Phone: 503-468-8646
  • Fax:
Mailing address:
  • Phone: 503-468-8646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6223
License Number StateOR

VIII. Authorized Official

Name: MS. LAUREN ELIZABETH MENGEDOHT
Title or Position: OWNER/CLINICIAN
Credential: LCSW
Phone: 503-468-8646