Healthcare Provider Details

I. General information

NPI: 1861480659
Provider Name (Legal Business Name): RUSSELL YOST LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 E MEDLOCK DR
PHOENIX AZ
85014-3214
US

IV. Provider business mailing address

904 E MEDLOCK DR
PHOENIX AZ
85014-3214
US

V. Phone/Fax

Practice location:
  • Phone: 623-349-1257
  • Fax:
Mailing address:
  • Phone: 623-349-1257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT0388
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0131
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: