Healthcare Provider Details

I. General information

NPI: 1366930554
Provider Name (Legal Business Name): LORI ANN HUMBERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 08/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 OLD SCOTTSVILLE ROAD
ALVATON KY
42122-9767
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 844-435-0900
  • Fax: 270-858-4029
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number253958
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: