Cannon Psychological Associates, PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

349 Issued in SC

Legal business name

CANNON PSYCHOLOGICAL ASSOCIATES, PC

Practice address

1376 Tiger Blvd Ste 210
Clemson, SC 29631-2654

Phone

(864) 654-7848

Fax

(864) 654-5777

NPI assigned

Oct 25, 2006

Last updated

Sep 6, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Elizabeth Tracy Goode

Title

Office Manager

Phone

(864) 654-7848

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ivra Yvette Pace, LPC

  • Mental Health Counselor
  • Walhalla, SC
  • NPI 1326378993
  NPD (past)
• Holly Lee Partin, LPC, NBCC, M.ED

  • Mental Health Counselor
  • Clemson, SC
  • NPI 1023122082
  NPD (past)
• Anne C Dibala, MD

  • Psychiatry Physician
  • Lebanon, VA
  • NPI 1487614301
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1447334198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1376 TIGER BLVD STE 210",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296312654",
            "telephone_number": "864-654-7848",
            "fax_number": "864-654-5777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1376 TIGER BLVD STE 210",
            "city": "CLEMSON",
            "state": "SC",
            "postal_code": "296312654",
            "telephone_number": "864-654-7848",
            "fax_number": "864-654-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANNON PSYCHOLOGICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "GOODE",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "TRACY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "864-654-7848",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "SC",
            "license": "349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PS0078",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Calhoun Health & Spine LLC
• Ryan Calhoun, DC
• Savannah Eliza Calvert, M.ED., ED.S., LPC-A
• Karen Ann Campbell, LMT
• Cannon Memorial Hospital (AnMed ENT - Clemson)
• Colton Chase Cantley, DPT, PT
• Matthew Cape, PTA
• Carc, Inc. (Clemson Area Retirement Center)
• Carolina Integrative Medicine, PA
• Carolina Oaks Clemson LLC

• Clinical Psychologist in Clemson, SC
• Providers in Clemson, SC by specialty
• Clinical Psychologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.