Healthcare Provider Details

I. General information

NPI: 1417555327
Provider Name (Legal Business Name): CORDIE LANENA BANKS LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CORDIE LANENA WILSON LPCA

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 MEYERS BAKER RD STE 200
LONDON KY
40741-3040
US

IV. Provider business mailing address

125 S MAIN CROSS ST
LOUISA KY
41230-1065
US

V. Phone/Fax

Practice location:
  • Phone: 606-878-3240
  • Fax: 606-878-4308
Mailing address:
  • Phone: 606-638-0938
  • Fax: 859-813-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number268212
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: