Healthcare Provider Details

I. General information

NPI: 1871775338
Provider Name (Legal Business Name): THOMAS E CANNON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 PRIDE DR STE B
HAMMOND LA
70401-9527
US

IV. Provider business mailing address

835 PRIDE DR STE B
HAMMOND LA
70401-9527
US

V. Phone/Fax

Practice location:
  • Phone: 985-543-4730
  • Fax: 985-543-4817
Mailing address:
  • Phone: 985-543-4730
  • Fax: 985-543-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: