Healthcare Provider Details

I. General information

NPI: 1992285696
Provider Name (Legal Business Name): KATHRYN T YORT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81-6587 MAMALAHOA HWY BLDG. C
KEALAKEKUA HI
96750
US

IV. Provider business mailing address

PO BOX 6335
KAMUELA HI
96743-6335
US

V. Phone/Fax

Practice location:
  • Phone: 808-323-2664
  • Fax: 808-323-2999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-5230-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: