MEDICARE: PEACE OF MIND COUNSELING AND ASSESSMENT, PLLC

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	101YP2500X	Professional Counselor
2	103TC0700X	Clinical Psychologist

General Provider Information

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

Provider Business Mailing Address
First Line	:	7820 N UNIVERSITY ST STE 104
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-8301
Country	:	US
Telephone Number	:	309-233-3410
Fax Number	:	309-326-4446

Provider Business Practice Location Address
First Line	:	7820 N UNIVERSITY ST STE 104
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-8301
Country	:	US
Telephone Number	:	309-231-6951
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	KYLE FOSKETT
Credential	:	PSYD
Telephone Number	:	309-233-3410

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	01/12/2026

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