Active NPI
Devaunier Cannon, LCSW
- Clinical Social Worker
- Grand Prairie, TX
National Provider Identifier
1023636289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 63841
- Practice address
- 3090 Outlet Pkwy Apt 317
Grand Prairie, TX 75052-7258 - Phone
- (254) 630-0734
- NPI assigned
- Jul 13, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 63841 | TX | Primary |
Addresses
Primary practice location
3090 Outlet Pkwy Apt 317
Grand Prairie, TX 75052-7258
Mailing address
3090 Outlet Pkwy Apt 317
Grand Prairie, TX 75052-7258
Phone (254) 630-0734
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63841 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594598400000",
"number": "1023636289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3090 OUTLET PKWY APT 317",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750527258",
"telephone_number": "254-630-0734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3090 OUTLET PKWY APT 317",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750527258",
"telephone_number": "254-630-0734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "DEVAUNIER",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-13",
"last_updated": "2020-07-13",
"certification_date": "2020-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "63841",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Prairie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.