Provider Demographics
NPI:1689049884
Name:BRENDA CANNON: COUNSELING & CONSULTING, P.C.
Entity Type:Organization
Organization Name:BRENDA CANNON: COUNSELING & CONSULTING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC, LPC
Authorized Official - Phone:307-851-9736
Mailing Address - Street 1:2020 E GRAND AVE
Mailing Address - Street 2:SUITE 285
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4383
Mailing Address - Country:US
Mailing Address - Phone:307-851-9736
Mailing Address - Fax:307-742-6702
Practice Address - Street 1:2020 E GRAND AVE
Practice Address - Street 2:SUITE 285
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4383
Practice Address - Country:US
Practice Address - Phone:307-851-9736
Practice Address - Fax:307-742-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1214101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty