Provider Demographics
NPI:1437831393
Name:CANNON PSYCHOLOGY
Entity type:Organization
Organization Name:CANNON PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-367-3368
Mailing Address - Street 1:3095 HIGHWAY 101 N.
Mailing Address - Street 2:SUITE 11 #1002
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37650 NORTHFORK RD
Practice Address - Street 2:
Practice Address - City:NEHALEM
Practice Address - State:OR
Practice Address - Zip Code:97131-9685
Practice Address - Country:US
Practice Address - Phone:858-699-4918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)