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General NPI Number Information
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NPI Number | 1316144819
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Entity Type | Individual
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Provider Name | CALLEEN ANN CANNON LCPC
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Gender | Female
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 845 W CENTER ST
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City | POCATELLO
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State | ID
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Zip | 83204-4205
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Country | US
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Telephone | 208-295-9430
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Fax | 208-213-5765
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Provider Business Mailing Address
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Address Line | 845 W CENTER ST
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City | POCATELLO
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State | ID
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Zip | 83204-4205
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Country | US
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Telephone | 208-295-9430
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Fax | 208-213-5765
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-4273
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License Number State | ID
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