Provider Demographics
NPI:1386878072
Name:CANNON, PAMELA KAY (LMSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:KAY
Last Name:CANNON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 RIATA DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-6481
Mailing Address - Country:US
Mailing Address - Phone:281-259-6254
Mailing Address - Fax:
Practice Address - Street 1:6 RIATA DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-6481
Practice Address - Country:US
Practice Address - Phone:281-259-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34511104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker