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General NPI Number Information
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NPI Number | 1548870264
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Entity Type | Organization
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Legal Business Name | THE CANNON COLLECTIVE, LLC
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 07/02/2023
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Provider Practice Location Address
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Address Line | 9401 INDIAN CREEK PKWY STE 180
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City | OVERLAND PARK
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State | KS
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Zip | 66210-2090
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Country | US
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Telephone | 913-210-0766
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Fax |
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Provider Business Mailing Address
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Address Line | 6920 W 162ND TER UNIT 7213
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City | OVERLAND PARK
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State | KS
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Zip | 66085-8255
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Country | US
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Telephone | 913-271-1771
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | EMMA CANNON
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Credential | MS, LCMFT
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Telephone | 913-210-0766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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