Healthcare Provider Details

I. General information

NPI: 1083176218
Provider Name (Legal Business Name): MINDFUL SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 I 55 N STE 208
JACKSON MS
39211-5931
US

IV. Provider business mailing address

PO BOX 12195
JACKSON MS
39236-2195
US

V. Phone/Fax

Practice location:
  • Phone: 601-292-6260
  • Fax: 601-487-8115
Mailing address:
  • Phone: 601-292-6260
  • Fax: 601-487-8115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHERRY BOULDIN
Title or Position: OWNER
Credential: LPC, NCC
Phone: 601-292-6260