MEDICARE: MR. LOREN CRONK LMFT

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
1	106H00000X	Marriage & Family Therapist	LMFT31544	CA

General Provider Information

NPI Number	:	1114121589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LOREN CRONK LMFT

Provider Business Mailing Address
First Line	:	PO BOX 71
Second Line	:
City	:	MOUNT SHASTA
State	:	CA
Zip	:	96067-0071
Country	:	US
Telephone Number	:	530-949-9989
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 S MOUNT SHASTA BLVD
Second Line	:
City	:	MOUNT SHASTA
State	:	CA
Zip	:	96067-2764
Country	:	US
Telephone Number	:	530-949-9989
Fax Number	:	844-644-3159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	10/14/2024

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