Healthcare Provider Details

I. General information

NPI: 1790604890
Provider Name (Legal Business Name): MINDED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 SISKIYOU BLVD
ASHLAND OR
97520-2400
US

IV. Provider business mailing address

11751 DEAD INDIAN MEMORIAL RD
ASHLAND OR
97520-9757
US

V. Phone/Fax

Practice location:
  • Phone: 541-625-9112
  • Fax: 310-692-9855
Mailing address:
  • Phone: 541-625-9112
  • Fax: 310-692-9855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA JEAN ANDERSEN
Title or Position: BUSINESS OWNER
Credential: LMFT
Phone: 949-344-6566