Christopher Canon, PH.D.
Individual provider Active NPI Clinical Psychologist · Willisburg, KY
NPI 1457742769 · NPPES record last updated Feb 9, 2015
Key facts
- NPI
- 1457742769
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- KY-00837 (KY)
- Practice address
- 2084 Main St
Willisburg, KY 40078-8199 - Phone
- (859) 375-9200
- Fax
- (859) 375-9202
- NPI assigned
- Feb 9, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KY-00837 | KY | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | KY-00837 | KY | Yes |
Addresses
Primary practice location
2084 Main St
Willisburg, KY 40078-8199
Mailing address
4230 Glens Creek Rd
Willisburg, KY 40078-8168
Phone (859) 797-6413
Other providers in Willisburg, KY
- Katelynn Raechelle Adams
- Angela Benz
- Calli Morgan Cox
- Joseph Michael Cox
- Cumberland Family Medical Center, Inc.
- Michael Dow
- Flaget Healthcare Inc
All providers in Willisburg, KY · Clinical Psychologist in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.