Provider Demographics
NPI:1659152619
Name:CANNON, PHILIP ANDREW (MS, MFT-I)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:ANDREW
Last Name:CANNON
Suffix:
Gender:M
Credentials:MS, MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5144 CREEK BEND CIR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4109
Mailing Address - Country:US
Mailing Address - Phone:423-284-5786
Mailing Address - Fax:
Practice Address - Street 1:1441 GUTHRIE DR NW STE 106
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3642
Practice Address - Country:US
Practice Address - Phone:423-284-5786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2318106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist