Healthcare Provider Details

I. General information

NPI: 1134066053
Provider Name (Legal Business Name): INSIGHTFUL MINDS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 BAYOU BLVD STE 34
PENSACOLA FL
32503-2682
US

IV. Provider business mailing address

1349 WITHERSPOON DR
PRATTVILLE AL
36066-4701
US

V. Phone/Fax

Practice location:
  • Phone: 850-275-9985
  • Fax:
Mailing address:
  • Phone: 850-275-9985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: TERRA SHISHIDO
Title or Position: OWNER
Credential:
Phone: 850-530-8304