Provider Demographics
NPI:1922385129
Name:SEXTON, WANDA (LPCC)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:SEXTON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-0356
Mailing Address - Country:US
Mailing Address - Phone:270-579-1095
Mailing Address - Fax:270-524-1577
Practice Address - Street 1:103 E. SOUTH ST.
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765
Practice Address - Country:US
Practice Address - Phone:270-579-1095
Practice Address - Fax:270-524-1577
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCPCC00220318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid