MEDICARE: ZACHARY CANNON LLPC

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	6451024095	MI

General Provider Information

NPI Number	:	1457158883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY CANNON LLPC

Provider Business Mailing Address
First Line	:	1740 W BIG BEAVER RD STE 107
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-3507
Country	:	US
Telephone Number	:	248-573-7417
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 GREEN RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-2948
Country	:	US
Telephone Number	:	248-573-7417
Fax Number	:

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

Provider Enumeration Date	:	02/25/2025
Last Update Date	:	02/25/2025

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Directions to “ ZACHARY CANNON LLPC” Practice Location

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