Provider Demographics
NPI:1699342840
Name:CANNON, SIMONE JN-MARIE (LPC)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:JN-MARIE
Last Name:CANNON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12718 LIMA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-1224
Mailing Address - Country:US
Mailing Address - Phone:832-788-0183
Mailing Address - Fax:
Practice Address - Street 1:633 E FERNHURST DR STE 1102
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1592
Practice Address - Country:US
Practice Address - Phone:281-940-8515
Practice Address - Fax:888-972-1582
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86022101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor