Provider Demographics
NPI:1114109717
Name:HILYARD, A. ELISSA (MS, LCMFT)
Entity Type:Individual
Prefix:MS
First Name:A.
Middle Name:ELISSA
Last Name:HILYARD
Suffix:
Gender:F
Credentials:MS, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 ALMA CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3626
Mailing Address - Country:US
Mailing Address - Phone:785-424-5134
Mailing Address - Fax:
Practice Address - Street 1:918 ALMA CT
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3626
Practice Address - Country:US
Practice Address - Phone:785-424-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCMFT 620106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200533520EMedicaid