Provider Demographics
NPI:1598956948
Name:YOST, KELLIE M (MA, LLP)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:M
Last Name:YOST
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25314 CROWN POINT CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1234
Mailing Address - Country:US
Mailing Address - Phone:517-677-2414
Mailing Address - Fax:
Practice Address - Street 1:23975 NOVI RD
Practice Address - Street 2:SUITE C-101
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2459
Practice Address - Country:US
Practice Address - Phone:517-367-0670
Practice Address - Fax:517-367-0681
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012258103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist