Provider Demographics
NPI:1225676034
Name:CANNON, GLYNN EDWARD (LPC)
Entity type:Individual
Prefix:MR
First Name:GLYNN
Middle Name:EDWARD
Last Name:CANNON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26756 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:AL
Mailing Address - Zip Code:35739-7624
Mailing Address - Country:US
Mailing Address - Phone:256-434-7505
Mailing Address - Fax:
Practice Address - Street 1:26756 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:AL
Practice Address - Zip Code:35739-7624
Practice Address - Country:US
Practice Address - Phone:256-434-7505
Practice Address - Fax:256-646-1265
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2482A101Y00000X
AL4546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor