Provider Demographics
NPI:1144238411
Name:YAZELL, KIMBERLY JEAN (PHD, LCSW, LCAC, MSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JEAN
Last Name:YAZELL
Suffix:
Gender:F
Credentials:PHD, LCSW, LCAC, MSW
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:JEAN
Other - Last Name:PARKHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3540 DURBIN RD
Mailing Address - Street 2:
Mailing Address - City:STOVER
Mailing Address - State:MO
Mailing Address - Zip Code:65078-1890
Mailing Address - Country:US
Mailing Address - Phone:317-828-6062
Mailing Address - Fax:
Practice Address - Street 1:3540 DURBIN RD
Practice Address - Street 2:
Practice Address - City:STOVER
Practice Address - State:MO
Practice Address - Zip Code:65078-1890
Practice Address - Country:US
Practice Address - Phone:317-828-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000490A101YA0400X
IN34005586A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530AMedicaid
IN150074Medicare PIN