Individual
BRENDA JEAN CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, NCC, LPC
Contact information
Practice address
1317 BOSWELL DR, LARAMIE, WY 82070-5453
(307) 851-9736
(307) 742-6702
Mailing address
1050 N 3RD ST, SUITE B1, LARAMIE, WY 82072-2544
(307) 742-4769
(307) 742-6702
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC #1214
WY
101YP2500X
Professional Counselor
LPC #1214
WY
Other
Enumeration date
06/04/2009
Last updated
10/10/2012
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