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General NPI Number Information
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NPI Number | 1447761275
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Entity Type | Individual
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Provider Name | KASSANDRA KATHLEEN YARBROUGH
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Gender | Female
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 415 N 26TH ST
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City | LAFAYETTE
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State | IN
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Zip | 47904-2895
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Country | US
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Telephone | 765-446-6573
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Fax |
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Provider Business Mailing Address
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Address Line | 415 N 26TH ST
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City | LAFAYETTE
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State | IN
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Zip | 47904-2895
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Country | US
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Telephone | 765-446-6573
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20043497A
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License Number State | IN
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