Organization
CANNON THERAPEUTIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TUCKER CROXALL CANNON LCSW (OWNER, PROVIDER)
(949) 244-9982
Entity
Organization
Contact information
Practice address
125 W MAIN ST UNIT 324, MIDWAY, UT 84049-8014
(949) 244-9982
Mailing address
125 W MAIN ST UNIT 324, MIDWAY, UT 84049-8014
(949) 244-9982
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
11/03/2025
Last updated
11/03/2025
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