Provider Demographics
NPI:1154450740
Name:CANNON CONSULTING LLC
Entity Type:Organization
Organization Name:CANNON CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-249-4757
Mailing Address - Street 1:62100 V 62 TRAIL
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401
Mailing Address - Country:US
Mailing Address - Phone:970-252-1577
Mailing Address - Fax:
Practice Address - Street 1:207 S 4TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3644
Practice Address - Country:US
Practice Address - Phone:970-249-4757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty