Individual
ANITA LAKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPP
Contact information
Practice address
1353 W MAIN ST STE 100, LEXINGTON, KY 40508-2065
(859) 245-2400
(859) 245-2443
Mailing address
1351 NEWTOWN PIKE, LEXINGTON, KY 40511-1275
(859) 253-1686
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
270058
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790731081
—
KY
Enumeration date
02/05/2010
Last updated
11/30/2021
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