MEDICARE: MS. KIMBERLEY LYNN YORE MS, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	4703102803	MI
2	101YP2500X	Professional Counselor	6401011301	MI

General Provider Information

NPI Number	:	1184974867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLEY LYNN YORE MS, LPC, NCC

Provider Business Mailing Address
First Line	:	4029 WEST MAIN ST. (4029)
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2763
Country	:	US
Telephone Number	:	269-290-4359
Fax Number	:	269-397-2287

Provider Business Practice Location Address
First Line	:	4029 WEST MAIN ST. (4029)
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2763
Country	:	US
Telephone Number	:	269-290-4359
Fax Number	:	269-397-2287

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	02/28/2019

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