Provider Demographics
NPI:1528607959
Name:MURRELL-CANNON, CANDICE LYNN (LCPC, LMHC, NCC)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:LYNN
Last Name:MURRELL-CANNON
Suffix:
Gender:F
Credentials:LCPC, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 W AGENCY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1667
Mailing Address - Country:US
Mailing Address - Phone:319-753-2300
Mailing Address - Fax:
Practice Address - Street 1:400 N 17TH ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-3452
Practice Address - Country:US
Practice Address - Phone:319-524-5734
Practice Address - Fax:319-524-5758
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074278101YM0800X
IL180012674101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180012674OtherIILINOIS DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION