CANNON PSYCHOLOGICAL ASSOCIATES, PC (NPI# 1447334198) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447334198 |
| Entity Type | Organization |
| Organization Name | CANNON PSYCHOLOGICAL ASSOCIATES, PC |
| Practice Address |
1376 Tiger Blvd Ste 210 Clemson SC 29631-2654 |
| Practice Telephone | 8646547848 |
| Practice Fax Number | 8646545777 |
| Mailing Telephone | 8646547848 |
| Mailing Fax Number | 8646545777 |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. ELIZABETH TRACY GOODE (OFFICE MANAGER) |
| Authorized Official Telephone | 8646547848 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
349 | SC | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | PS0078 | 05 |
| Street Address |
1376 TIGER BLVD STE 210 |
| City | CLEMSON |
| State | SC |
| Zip Code | 29631-2654 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326378993 | Ivra Yvette Pace | Counselor | 1376 Tiger Blvd Ste 210, Cannon Psychological Associates, Clemson, SC 29631-2654 | 2010-01-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063059038 | James Ryan Small | Specialist/Technologist | 212 Vista Cir, Clemson, SC 29631 | 2019-12-09 |
| 1811559883 | Cheyenne Leigh Reynolds | Specialist/Technologist | 100 Reeves Way, Clemson, SC 29631 | 2019-07-01 |
| 1912474792 | Andrea Bagley Stokes | Physical Therapist | 500-1 Old Greenville Hwy # 1, Clemson, SC 29631 | 2018-10-30 |
| 1114426178 | Intouch Pharmacy LLC | Pharmacy | 105 Wall Street, Suite 10b, Clemson, SC 29631 | 2018-02-06 |
| 1881117695 | Community Pharmacy Group, Inc. | Pharmacy | 143 Thomas Green Blvd, Clemson, SC 29631 | 2017-07-24 |
| 1295286276 | James Matthew Mills | Occupational Therapist | 101 Chapman Rd, Clemson, SC 29631 | 2016-10-14 |
| 1558769141 | Virginia Bridges Gaulin | Counselor | 209 Pendleton Rd Ste C, Clemson, SC 29631 | 2014-12-12 |
| 1437580628 | Amanda Martin Eubanks | Speech-Language Pathologist | 101 Chapman Road Suite 202, Clemson, SC 29631 | 2013-12-12 |
| 1437408499 | Fort Hill Family Dentistry, Pa | Clinic/Center | 124 Strode Circle, Clemson, SC 29631 | 2012-09-06 |
| 1942511738 | Theresa S Ritter | Counselor | 386 College Avenue, Suite A, Clemson, SC 29631 | 2010-06-25 |
| Find all providers in zip 29631 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124353776 | Heidi Zinzow | Psychologist | 400 College Ave Ste 4, Clemson, SC 29631-2925 | 2009-10-14 |
| 1285984807 | Nadine Grissett Mccallum | Psychologist | 398 College Ave, Clemson, SC 29631 | 2012-09-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770181125 | Christopher Moylan | Psychologist | 200 Patewood Dr Bldg A, Greenville, SC 29615-3593 | 2020-10-16 |
| 1396353736 | Corvus Psychotherapy, LLC | Psychologist | 1114 Battery Creek Rd, Beaufort, SC 29902-6309 | 2020-07-22 |
| 1861000978 | Lauren Gay Fontenot | Psychologist | 3453 Pelham Rd Ste 107, Greenville, SC 29615-7400 | 2020-07-15 |
| 1306497151 | Susan K Jones LLC | Psychologist | 105 Central Ave Unit 7, Goose Creek, SC 29445-3269 | 2019-09-24 |
| 1518515097 | Warrenetta Crawford Mann | Psychologist | 1409 Devine Street Thomson Building, Columbia, SC 29208-0001 | 2019-08-28 |
| 1881247476 | Reliant Mental Health Services LLC | Psychologist | 221- 223 Adley Way Ste 221, Greenville, SC 29607-6511 | 2019-07-23 |
| 1487212742 | Alysha Buonerba | Psychologist | 211 King St Ste 206, Charleston, SC 29401-3184 | 2019-06-03 |
| 1497212435 | Katherine Elizabeth Bischoff | Psychologist | 388 Huger St, Charleston, SC 29403-4126 | 2019-02-26 |
| 1326512088 | Roper Saint Francis Physicians Network | Psychologist | 2097 Henry Tecklenburg Dr Ste 220, Charleston, SC 29414-5739 | 2019-01-16 |
| 1861964207 | Erin Joy Schuyler | Psychologist | 26 Barn Owl Ct, Columbia, SC 29209-4488 | 2018-12-26 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CANNON PSYCHOLOGICAL ASSOCIATES, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.