Individual
JENNIFER CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MHPS-PSS
Contact information
Practice address
1411 WUNSCHE LOOP, #2079, SPRING, TX 77373-2079
(832) 554-6541
Mailing address
PO BOX 2079, SPRING, TX 77383-2079
(832) 554-6541
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
172A00000X
Driver
—
—
174H00000X
Health Educator
—
—
175T00000X
Peer Specialist
Primary
50025-0820
TX
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50025-0821
TEXAS CERTIFICATION BOARD
TX
05
—
D18305791
—
TX
Enumeration date
10/09/2020
Last updated
01/04/2022
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