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General NPI Number Information
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NPI Number | 1619360500
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Entity Type | Individual
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Provider Name | KEVIN E KRUM MA LLP
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Gender | Male
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 2981 E STERNBERG RD
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City | FRUITPORT
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State | MI
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Zip | 49415-8625
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Country | US
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Telephone | 231-578-9664
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Fax | 616-336-2475
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Provider Business Mailing Address
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Address Line | 2981 E STERNBERG RD
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City | FRUITPORT
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State | MI
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Zip | 49415-8625
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Country | US
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Telephone | 231-578-9664
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Fax | 616-336-2475
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6301011184
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License Number State | MI
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