Healthcare Provider Details

I. General information

NPI: 1841005857
Provider Name (Legal Business Name): ENSIGHT MENTAL HEALTH & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N 6TH ST STE G1
PEKIN IL
61554-3320
US

IV. Provider business mailing address

111 N 6TH ST STE G1
PEKIN IL
61554-3320
US

V. Phone/Fax

Practice location:
  • Phone: 309-810-4407
  • Fax: 309-354-2041
Mailing address:
  • Phone: 309-810-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE RAE SMITH
Title or Position: OWNER
Credential: NP
Phone: 309-453-0812