Provider Demographics
NPI:1720310485
Name:LAKES, ANITA (LPP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:LAKES
Suffix:
Gender:F
Credentials:LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 NEWTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1275
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:
Practice Address - Street 1:1353 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2065
Practice Address - Country:US
Practice Address - Phone:859-245-2400
Practice Address - Fax:859-245-2443
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270058103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid
000000689474OtherANTHEM BCBS
9392643OtherAETNA