Provider Demographics
NPI:1548870264
Name:THE CANNON COLLECTIVE, LLC
Entity type:Organization
Organization Name:THE CANNON COLLECTIVE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCMFT
Authorized Official - Phone:913-210-0766
Mailing Address - Street 1:6920 W 162ND TER UNIT 7213
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66085-8255
Mailing Address - Country:US
Mailing Address - Phone:913-271-1771
Mailing Address - Fax:
Practice Address - Street 1:9401 INDIAN CREEK PKWY STE 180
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2090
Practice Address - Country:US
Practice Address - Phone:913-210-0766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty