Healthcare Provider Details

I. General information

NPI: 1871411801
Provider Name (Legal Business Name): KIND MIND THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 10/08/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MAIN ST #865
JACKSONVILLE OR
97530
US

IV. Provider business mailing address

PO BOX 865
JACKSONVILLE OR
97530-0865
US

V. Phone/Fax

Practice location:
  • Phone: 530-475-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BLISS BOUTIN
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA
Phone: 916-799-5659