Provider Demographics
NPI:1255706735
Name:CANTON, JANICE ALLISON
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:ALLISON
Last Name:CANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15708 HATTERLY LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4180
Mailing Address - Country:US
Mailing Address - Phone:405-471-4792
Mailing Address - Fax:
Practice Address - Street 1:4416 SAINT GREGORY DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8331
Practice Address - Country:US
Practice Address - Phone:405-471-4792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7389101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health