Provider Demographics
NPI:1841005857
Name:ENSIGHT MENTAL HEALTH & WELLNESS PLLC
Entity type:Organization
Organization Name:ENSIGHT MENTAL HEALTH & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:309-453-0812
Mailing Address - Street 1:111 N 6TH ST STE G1
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3320
Mailing Address - Country:US
Mailing Address - Phone:309-810-4407
Mailing Address - Fax:
Practice Address - Street 1:110 N 5TH ST STE G1
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3363
Practice Address - Country:US
Practice Address - Phone:309-810-4407
Practice Address - Fax:309-354-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-08
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty