Provider Demographics
NPI:1790435360
Name:YOST, JUSTIN DAVID
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DAVID
Last Name:YOST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W MONROE ST STE A&600B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2079
Mailing Address - Country:US
Mailing Address - Phone:517-630-1570
Mailing Address - Fax:
Practice Address - Street 1:950 W MONROE ST STE A&600B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2079
Practice Address - Country:US
Practice Address - Phone:517-630-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-26
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker