| Doctor Name: | DR. CHRISTOPHER CANON |
| NPI Number: | 1457742769 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | KY-00837 |
| Business Practice Address: | 2084 Main St Willisburg, KY - 400788199 |
| Business Phone Number: | 8593759200 |
| Business Fax Number: | 8593759202 |
| Mailing Address: | 4230 Glens Creek Rd, WILLISBURG |
| State: | KY |
| Postal Code: | 400788168 |
| Phone Number: | 8597976413 |
| Fax Number: | |
| NPI Enumeration Date: | 02/09/2015 |
| NPI Last Update Date: | 02/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | KY-00837 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |