MEDICARE: INTENTIONAL MIND COUNSELING, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1801747597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTENTIONAL MIND COUNSELING, LLC

Provider Business Mailing Address
First Line	:	7628 GRIFFON DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-5256
Country	:	US
Telephone Number	:	225-234-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	7628 GRIFFON DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-5256
Country	:	US
Telephone Number	:	225-234-1000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BREYANA WHEELER
Credential	:	LPC
Telephone Number	:	225-234-1000

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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