Provider Demographics
NPI:1891430484
Name:HYLTON, LACEY T (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:T
Last Name:HYLTON
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WINNFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71483-3061
Mailing Address - Country:US
Mailing Address - Phone:318-209-4033
Mailing Address - Fax:318-209-4043
Practice Address - Street 1:1607 MAPLE ST
Practice Address - Street 2:
Practice Address - City:WINNFIELD
Practice Address - State:LA
Practice Address - Zip Code:71483-3061
Practice Address - Country:US
Practice Address - Phone:318-209-4033
Practice Address - Fax:318-209-4043
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-612103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst