Provider Demographics
NPI:1184172215
Name:CANNON, COURTNEY (MS LPC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S CENTRAL AVE STE 200B
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-1637
Mailing Address - Country:US
Mailing Address - Phone:724-338-2292
Mailing Address - Fax:
Practice Address - Street 1:311 S CENTRAL AVE STE 200B
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-1637
Practice Address - Country:US
Practice Address - Phone:724-338-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health