=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871411801
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIND MIND THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2026
-----------------------------------------------------
Last Update Date | 07/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 FRIENDSHIP ST
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97520-3020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-799-5659
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 FRIENDSHIP ST
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97520-3020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-799-5659
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | BLISS BOUTIN
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 916-799-5659
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------