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General NPI Number Information
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NPI Number | 1134976061
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Entity Type | Organization
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Legal Business Name | CANNON PSYCHOLOGICAL LLC
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Dates
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Enumeration Date | 04/30/2024
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 12058 SAN JOSE BLVD STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8669
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Country | US
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Telephone | 43-738-2999
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Fax |
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Provider Business Mailing Address
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Address Line | 3075 ORANGE PICKER RD
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City | JACKSONVILLE
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State | FL
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Zip | 32223-0882
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Country | US
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Telephone | 352-339-6751
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. BRITTANY CANNON
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Credential | PHD
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Telephone | 352-339-6751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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