Provider Demographics
NPI:1023903846
Name:CANON, BRENNAN
Entity type:Individual
Prefix:
First Name:BRENNAN
Middle Name:
Last Name:CANON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 W BRITTON RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1505
Mailing Address - Country:US
Mailing Address - Phone:405-840-9000
Mailing Address - Fax:
Practice Address - Street 1:2113 W BRITTON RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1505
Practice Address - Country:US
Practice Address - Phone:405-840-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health