Provider Demographics
NPI:1609253517
Name:YOST, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:YOST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 MAPLE LAWN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2615
Mailing Address - Country:US
Mailing Address - Phone:410-804-5543
Mailing Address - Fax:
Practice Address - Street 1:8160 MAPLE LAWN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2615
Practice Address - Country:US
Practice Address - Phone:410-804-5543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP5163101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional