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General NPI Number Information
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NPI Number | 1487594198
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Entity Type | Organization
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Legal Business Name | LUMIRA BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 1957 THOMPSON RD STE J
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City | COOS BAY
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State | OR
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Zip | 97420-2040
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Country | US
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Telephone | 518-791-2267
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Fax |
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Provider Business Mailing Address
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Address Line | 1957 THOMPSON RD STE J
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City | COOS BAY
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State | OR
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Zip | 97420-2040
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Country | US
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Telephone | 518-791-2267
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADAM CLARK
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Credential | LCSW
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Telephone | 518-791-2267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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