Kimberly J Youngblood, LICDC, ICDAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

081242 Issued in OH

Practice address

690 Northland Blvd
Cincinnati, OH 45240-3214

Phone

(513) 549-2681

Fax

(513) 445-8286

NPI assigned

Feb 21, 2011

Last updated

Jul 6, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Youngblood Counseling and Consultation Services LLC

  • Mental Health Counselor
  • Cincinnati, OH
  • NPI 1144931973
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1043517451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7753 BITTEROOT LN",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452241172",
            "telephone_number": "513-505-4145",
            "fax_number": "513-445-8286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 NORTHLAND BLVD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452403214",
            "telephone_number": "513-549-2681",
            "fax_number": "513-445-8286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNGBLOOD",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "LICDC, ICDAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-02-21",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "081242",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0334355",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wallace Howard Young, O.D.
• Wesley Winston Young, MD
• Youngblood Counseling and Consultation Services LLC
• Anthony Lee Youngblood III
• Emily McBride Youngblood, MD
• Latasha M Youngblood
• Lisa Youngblood
• Alexandra Younger, LPN
• Bruce Younger, MD
• Christina Younger

• Addiction (Substance Use Disorder) Counselor in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.