# CANNON THERAPEUTIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497624951
- **Authorized official:** TUCKER CROXALL CANNON LCSW (OWNER, PROVIDER)
- **Authorized official phone:** (949) 244-9982

## Contact information

- **Practice address:** 125 W MAIN ST UNIT 324, MIDWAY, UT 84049-8014
- **Practice address phone:** (949) 244-9982
- **Mailing address:** 125 W MAIN ST UNIT 324, MIDWAY, UT 84049-8014
- **Mailing address phone:** (949) 244-9982

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 11/03/2025
- **Last updated:** 11/03/2025