Individual provider Active NPI

Daisha Renee Cannon, LMHCA

  • Mental Health Counselor
  • Kirkland, WA
National Provider Identifier
1265104491
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MC61197776 Issued in WA
Practice address
312 11TH Ave W Ste 201
Kirkland, WA 98033-5326
Phone
(425) 576-1817
NPI assigned
Oct 5, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MC61197776 WA Primary

Addresses

Primary practice location

312 11TH Ave W Ste 201
Kirkland, WA 98033-5326

Mailing address

12124 SE 292ND St
Auburn, WA 98092-2075
Phone (253) 266-0183

Other names 1

  • Ms. Daisha Renee Roberts-Kirby Former name

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MC61197776WAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Family Psychological Services of Kirkland, PS CurrentSince Aug 7, 2022 Accepting new patients

Locations

312 11th Ave W
Ste 201
Kirkland, WA 98033
Phone (425) 576-1817

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1265104491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12124 SE 292ND ST",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980922075",
            "telephone_number": "253-266-0183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 11TH AVE W STE 201",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980335326",
            "telephone_number": "425-576-1817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "DAISHA",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "LMHCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-05",
        "last_updated": "2021-10-05",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC61197776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAISHA",
            "last_name": "ROBERTS-KIRBY",
            "middle_name": "RENEE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.