MEDICARE: BLOOMING MINDS COUNSELING 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1851247167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOMING MINDS COUNSELING PLLC

Provider Business Mailing Address
First Line	:	PO BOX 25
Second Line	:
City	:	MT ZION
State	:	IL
Zip	:	62549-0025
Country	:	US
Telephone Number	:	217-521-4037
Fax Number	:

Provider Business Practice Location Address
First Line	:	3767 E US ROUTE 36
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-5085
Country	:	US
Telephone Number	:	217-521-4037
Fax Number	:

Authorized Official
Title or Position	:	LCSW/PWNER
Name	:	AMANDA FISHER
Credential	:	LCSW
Telephone Number	:	217-521-4037

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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