=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326947896
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUMORA MENTAL HEALTH AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2026
-----------------------------------------------------
Last Update Date | 11/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3559 NATIONAL DR
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97504-4035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 458-220-7230
-----------------------------------------------------
Fax | 458-229-8416
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3559 NATIONAL DR
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97504-4035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 458-220-7230
-----------------------------------------------------
Fax | 458-229-8416
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING MANAGER
-----------------------------------------------------
Name | GRACE AUERBACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-552-6054
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------