MEDICARE: KIM R YUSKIS LCSW

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	101YP2500X	Professional Counselor	992820	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	992820	OTHER	CO	LCSW LICENSE

General Provider Information

NPI Number	:	1548430481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM R YUSKIS LCSW

Provider Business Mailing Address
First Line	:	3045 YATES ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-1650
Country	:	US
Telephone Number	:	303-433-3326
Fax Number	:	303-433-3307

Provider Business Practice Location Address
First Line	:	3045 YATES ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-1650
Country	:	US
Telephone Number	:	303-433-3326
Fax Number	:	303-433-3307

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

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	03/06/2008

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