Healthcare Provider Details

I. General information

NPI: 1073477402
Provider Name (Legal Business Name): PEACE OF MIND COUNSELING AND ASSESSMENT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7820 N UNIVERSITY ST STE 104
PEORIA IL
61614-8301
US

IV. Provider business mailing address

7820 N UNIVERSITY ST STE 104
PEORIA IL
61614-8301
US

V. Phone/Fax

Practice location:
  • Phone: 309-231-6951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KYLE FOSKETT
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 309-231-6951