MEDICARE: DR. KRISTI B CANNON PH.D., LPC, NCC

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	101YM0800X	Mental Health Counselor	61756	TX

General Provider Information

NPI Number	:	1447520044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTI B CANNON PH.D., LPC, NCC

Provider Business Mailing Address
First Line	:	4611 BEE CAVE RD
Second Line	:	SUITE 105
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5220
Country	:	US
Telephone Number	:	512-329-5004
Fax Number	:	512-329-5904

Provider Business Practice Location Address
First Line	:	4611 BEE CAVE RD
Second Line	:	SUITE 105
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5220
Country	:	US
Telephone Number	:	512-329-5004
Fax Number	:	512-329-5904

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

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	01/12/2012

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