Individual
DAVE CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
704 E 4TH AVE, POST FALLS, ID 83854-7559
(208) 661-0553
Mailing address
14615 REAGAN CT, RATHDRUM, ID 83858-8327
(208) 661-0553
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
ID
Other
Enumeration date
08/28/2023
Last updated
08/28/2023
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