Provider Demographics
NPI:1720337215
Name:CANNON, ALISON RHODES (LPC)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:RHODES
Last Name:CANNON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 DAYTONA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2510
Mailing Address - Country:US
Mailing Address - Phone:314-276-4942
Mailing Address - Fax:
Practice Address - Street 1:8050 DAYTONA DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-2510
Practice Address - Country:US
Practice Address - Phone:314-276-4942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010021558101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor