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General NPI Number Information
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NPI Number | 1659152619
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Entity Type | Individual
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Provider Name | PHILIP ANDREW CANNON MS, MFT-I
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Gender | Male
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 1441 GUTHRIE DR NW STE 106
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City | CLEVELAND
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State | TN
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Zip | 37311-3642
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Country | US
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Telephone | 423-284-5786
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Fax |
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Provider Business Mailing Address
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Address Line | 5144 CREEK BEND CIR NW
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City | CLEVELAND
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State | TN
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Zip | 37312-4109
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Country | US
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Telephone | 423-284-5786
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2318
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License Number State | TN
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