Healthcare Provider Details

I. General information

NPI: 1245155142
Provider Name (Legal Business Name): KANNON COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 N HEIGHTS RD
SHERIDAN WY
82801-2129
US

IV. Provider business mailing address

1326 N HEIGHTS RD
SHERIDAN WY
82801-2129
US

V. Phone/Fax

Practice location:
  • Phone: 702-715-2599
  • Fax: 702-715-2599
Mailing address:
  • Phone: 702-715-2599
  • Fax: 702-715-2599

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: AMANDA PARKS
Title or Position: OWNER/PROVIDER
Credential:
Phone: 702-715-2599