Provider Demographics
NPI:1760031942
Name:HYLBERT, LAURA ELLEN (LCSW, ASDCS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:HYLBERT
Suffix:
Gender:F
Credentials:LCSW, ASDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-1375
Mailing Address - Country:US
Mailing Address - Phone:888-816-1469
Mailing Address - Fax:859-788-2014
Practice Address - Street 1:304 E MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-1375
Practice Address - Country:US
Practice Address - Phone:888-816-1469
Practice Address - Fax:859-788-2014
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6095104100000X
KY2553551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid