Healthcare Provider Details

I. General information

NPI: 1538620331
Provider Name (Legal Business Name): SHEILA LYNN CANNON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 PHYSICIANS PARK STE 304
POPLAR BLUFF MO
63901-3930
US

IV. Provider business mailing address

110 S 2ND ST
ELLINGTON MO
63638-9400
US

V. Phone/Fax

Practice location:
  • Phone: 573-727-5500
  • Fax: 573-399-2646
Mailing address:
  • Phone: 573-663-2313
  • Fax: 573-663-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019009239
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: