Provider Demographics
NPI:1639358591
Name:CORNWELL, LOIS ANNETTE (LPCC)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:ANNETTE
Last Name:CORNWELL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:ANNETTE
Other - Last Name:ROYSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0790
Mailing Address - Country:US
Mailing Address - Phone:606-329-8588
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:57 DORA LN
Practice Address - Street 2:
Practice Address - City:GREENUP
Practice Address - State:KY
Practice Address - Zip Code:41144-1187
Practice Address - Country:US
Practice Address - Phone:606-473-4773
Practice Address - Fax:606-473-7335
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103327101YP2500X
KY1309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100283620Medicaid
000393387OtherUNITED BEHAVIORAL HEALTH
000000583135OtherANTHEM BCBS
12219604OtherCAQH