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General NPI Number Information
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NPI Number | 1689049884
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Entity Type | Organization
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Legal Business Name | BRENDA CANNON: COUNSELING & CONSULTING, P.C.
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 2020 E GRAND AVE SUITE 285
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City | LARAMIE
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State | WY
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Zip | 82070-4383
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Country | US
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Telephone | 307-851-9736
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Fax | 307-742-6702
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Provider Business Mailing Address
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Address Line | 2020 E GRAND AVE SUITE 285
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City | LARAMIE
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State | WY
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Zip | 82070-4383
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Country | US
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Telephone | 307-851-9736
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Fax | 307-742-6702
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. BRENDA JEAN CANNON
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Credential | MS, NCC, LPC
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Telephone | 307-851-9736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1214
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1214
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License Number State | WY
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