MEDICARE: DR. JUDITH CANNON PHD

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	106H00000X	Marriage & Family Therapist	1918	TX

General Provider Information

NPI Number	:	1790996122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH CANNON PHD

Provider Business Mailing Address
First Line	:	7682 JULIETTE LOW DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-4176
Country	:	US
Telephone Number	:	214-728-9557
Fax Number	:

Provider Business Practice Location Address
First Line	:	7682 JULIETTE LOW DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-4176
Country	:	US
Telephone Number	:	214-728-9557
Fax Number	:

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	09/18/2025

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