Provider Demographics
NPI:1629643614
Name:KIMBERLY YUDT, LICENSED CLINICAL SOCIAL WORKER CORP.
Entity Type:Organization
Organization Name:KIMBERLY YUDT, LICENSED CLINICAL SOCIAL WORKER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:YUDT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:310-882-8297
Mailing Address - Street 1:650 HAMPSHIRE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2540
Mailing Address - Country:US
Mailing Address - Phone:805-601-6700
Mailing Address - Fax:
Practice Address - Street 1:660 HAMPSHIRE RD STE 108
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2554
Practice Address - Country:US
Practice Address - Phone:805-497-0605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1417429952OtherKIMBERLY YUDT, LCSW