=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588525802
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDFUL SOLUTIONS COUNSELING COLLECTIVE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2025
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 971 US HIGHWAY 202 N STE N
-----------------------------------------------------
City | BRANCHBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08876-3757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-570-4492
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 971 US HIGHWAY 202 N STE N
-----------------------------------------------------
City | BRANCHBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08876-3757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-570-4492
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROFESSIONAL COUNSEL
-----------------------------------------------------
Name | DOUGLAS BRYANT SROUR
-----------------------------------------------------
Credential | LPC, LMHC
-----------------------------------------------------
Telephone | 914-570-4492
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------