Provider Demographics
NPI:1477863314
Name:YOST, KIMBERLY JOY (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JOY
Last Name:YOST
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 TAFT AVE
Mailing Address - Street 2:SUITE 030
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6296
Mailing Address - Country:US
Mailing Address - Phone:630-204-2359
Mailing Address - Fax:
Practice Address - Street 1:346 TAFT AVE
Practice Address - Street 2:SUITE 030
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6296
Practice Address - Country:US
Practice Address - Phone:630-698-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007354101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional