Provider Demographics
NPI:1801348115
Name:GREYSON-BOST, KIMBERLY (LCPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GREYSON-BOST
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11361 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-8851
Mailing Address - Country:US
Mailing Address - Phone:815-270-0168
Mailing Address - Fax:855-564-1779
Practice Address - Street 1:11361 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-8851
Practice Address - Country:US
Practice Address - Phone:815-270-0168
Practice Address - Fax:855-564-1779
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012442101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional