Healthcare Provider Details

I. General information

NPI: 1437831393
Provider Name (Legal Business Name): CANNON PSYCHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 FAIR OAKS BLVD STE 100
SACRAMENTO CA
95864-7200
US

IV. Provider business mailing address

3626 FAIR OAKS BLVD STE 100
SACRAMENTO CA
95864-7200
US

V. Phone/Fax

Practice location:
  • Phone: 858-367-3368
  • Fax:
Mailing address:
  • Phone: 858-367-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. CASSANDRA CANNON
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 858-367-3368