Healthcare Provider Details

I. General information

NPI: 1205333986
Provider Name (Legal Business Name): LAURA SECORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGH ST
HAZARD KY
41701-1310
US

IV. Provider business mailing address

369 W VINE ST APT 1906
LEXINGTON KY
40507-1697
US

V. Phone/Fax

Practice location:
  • Phone: 859-279-2067
  • Fax:
Mailing address:
  • Phone: 859-279-2067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number264406
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: