Provider Demographics
NPI:1659366706
Name:YOCUM, CAROLYN B (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:B
Last Name:YOCUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 72 BOX 1516
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65779-9705
Mailing Address - Country:US
Mailing Address - Phone:417-880-6653
Mailing Address - Fax:417-282-1249
Practice Address - Street 1:622 W BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-5501
Practice Address - Country:US
Practice Address - Phone:417-880-6653
Practice Address - Fax:417-282-1249
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020075481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494801046Medicaid
MOMA2296001Medicare PIN