Healthcare Provider Details

I. General information

NPI: 1063705705
Provider Name (Legal Business Name): LAURA HUSBAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 E BROADWAY
LOUISVILLE KY
40204-1037
US

IV. Provider business mailing address

101 W MUHAMMAD ALI BLVD
LOUISVILLE KY
40202-1423
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-8010
  • Fax: 502-813-4451
Mailing address:
  • Phone: 708-974-5817
  • Fax: 708-371-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3998
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: