MEDICARE: MARY ANN CORNISH LPCC-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	267762	KY
2	101YM0800X	Mental Health Counselor	246798	KY
3	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124684105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN CORNISH LPCC-S

Provider Business Mailing Address
First Line	:	PO BOX 1080
Second Line	:
City	:	BURKESVILLE
State	:	KY
Zip	:	42717-1080
Country	:	US
Telephone Number	:	270-858-6655
Fax Number	:	270-858-4029

Provider Business Practice Location Address
First Line	:	1150 BYPASS N
Second Line	:
City	:	LAWRENCEBURG
State	:	KY
Zip	:	40342-9453
Country	:	US
Telephone Number	:	844-435-0900
Fax Number	:	270-858-4029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	04/08/2026

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Directions to “ MARY ANN CORNISH LPCC-S” Practice Location

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