Healthcare Provider Details

I. General information

NPI: 1659254845
Provider Name (Legal Business Name): KYLA ANN HURLOCK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8425 E RAYMOND ST
INDIANAPOLIS IN
46239-9426
US

IV. Provider business mailing address

19386 AMBER WAY
NOBLESVILLE IN
46060-8384
US

V. Phone/Fax

Practice location:
  • Phone: 317-532-1850
  • Fax:
Mailing address:
  • Phone: 765-757-0326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012139A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: