Provider Demographics
NPI:1720324593
Name:CANNON, RACHEL (AMFT)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 KIPANA AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-0341
Mailing Address - Country:US
Mailing Address - Phone:818-850-6650
Mailing Address - Fax:
Practice Address - Street 1:2378 KIPANA AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-0341
Practice Address - Country:US
Practice Address - Phone:818-850-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2403101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor