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NPI Code Detail

MEDICARE: MR. DONALD ALDEN CRONK III M.S., LMHC

MEDICARE: MR. DONALD ALDEN CRONK III M.S., LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor39000750AIN

General Provider Information

NPI Number : 1013054345
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DONALD ALDEN CRONK III M.S., LMHC
Provider Business Mailing Address
First Line : 616 E COLFAX AVE
Second Line :
City : SOUTH BEND
State : IN
Zip : 46617-2827
Country : US
Telephone Number : 574-277-7734
Fax Number : 574-277-7734
Provider Business Practice Location Address
First Line : 616 E COLFAX AVE
Second Line :
City : SOUTH BEND
State : IN
Zip : 46617-2827
Country : US
Telephone Number : 574-277-7734
Fax Number : 574-277-7734
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 07/08/2007

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