Healthcare Provider Details

I. General information

NPI: 1487516100
Provider Name (Legal Business Name): ENLIGHTENED MIND COUNSELING & CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S FOUNTAIN AVE
SPRINGFIELD OH
45506-2223
US

IV. Provider business mailing address

509 S FOUNTAIN AVE
SPRINGFIELD OH
45506-2223
US

V. Phone/Fax

Practice location:
  • Phone: 309-645-5291
  • Fax: 309-645-5291
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BROOKE SNOW
Title or Position: OWNER/CLINICIAN
Credential: M.A, LPCC-S
Phone: 309-645-5291