Provider Demographics
NPI:1356906788
Name:MIND SOLUTIONS LLC
Entity type:Organization
Organization Name:MIND SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:PSS
Authorized Official - Phone:503-206-8856
Mailing Address - Street 1:3311 NE MLK JR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2086
Mailing Address - Country:US
Mailing Address - Phone:503-206-8856
Mailing Address - Fax:503-327-8318
Practice Address - Street 1:11 SW GIBBS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4660
Practice Address - Country:US
Practice Address - Phone:503-206-8856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)