MEDICARE: MIND SOLUTIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1356906788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	3311 NE MLK JR BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-2086
Country	:	US
Telephone Number	:	503-206-8856
Fax Number	:	503-327-8318

Provider Business Practice Location Address
First Line	:	11 SW GIBBS ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-4660
Country	:	US
Telephone Number	:	503-206-8856
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JERMAINE CHRISTOPHER MASON
Credential	:	PSS
Telephone Number	:	503-206-8856

Provider Enumeration Date	:	05/01/2019
Last Update Date	:	11/01/2023

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Directions to “MIND SOLUTIONS LLC ” Practice Location

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