MEDICARE: ERIN CANNON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	90250	TX

General Provider Information

NPI Number	:	1164262838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN CANNON LPC

Provider Business Mailing Address
First Line	:	300 N AKARD ST APT 1217
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-3456
Country	:	US
Telephone Number	:	219-484-8345
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N AKARD ST APT 1217
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-3456
Country	:	US
Telephone Number	:	219-484-8345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	05/29/2024

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Directions to “ ERIN CANNON LPC” Practice Location

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