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Individual

MS. TERESA MAE CANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMSW

Contact information

Practice address
1605 ROCK PRAIRIE RD STE 212, BRYAN COLLEGE STATION OUTPATIENT CLINIC, COLLEGE STATION, TX 77845-8358
(979) 680-0361
(979) 693-2962
Mailing address
3712 RAVENWOOD DRIVE, BRYAN, TX 77802
(979) 680-0361
(979) 693-2962

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
15534
TX

Other

Enumeration date
07/21/2006
Last updated
07/08/2007
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