Healthcare Provider Details

I. General information

NPI: 1578195814
Provider Name (Legal Business Name): KIM MARIE YOUNG-TOLSDORF LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 SW PLAZA SHOPS LN
ANKENY IA
50023-7080
US

IV. Provider business mailing address

1030 5TH AVE SE STE 3000
CEDAR RAPIDS IA
52403-2416
US

V. Phone/Fax

Practice location:
  • Phone: 515-508-1150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number096846
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: