Healthcare Provider Details

I. General information

NPI: 1629643614
Provider Name (Legal Business Name): KIMBERLY YUDT, LICENSED CLINICAL SOCIAL WORKER CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2021
Last Update Date: 05/23/2021
Certification Date: 05/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 HAMPSHIRE RD STE 108
WESTLAKE VILLAGE CA
91361-2554
US

IV. Provider business mailing address

650 HAMPSHIRE RD STE 200
WESTLAKE VILLAGE CA
91361-2540
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-0605
  • Fax:
Mailing address:
  • Phone: 805-601-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY JOANNE YUDT
Title or Position: CEO, FOUNDER
Credential: LCSW
Phone: 310-882-8297