Provider Demographics
NPI:1114121589
Name:CRONK, LOREN (LMFT)
Entity type:Individual
Prefix:MR
First Name:LOREN
Middle Name:
Last Name:CRONK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-0071
Mailing Address - Country:US
Mailing Address - Phone:530-949-9989
Mailing Address - Fax:
Practice Address - Street 1:1180 S MOUNT SHASTA BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2764
Practice Address - Country:US
Practice Address - Phone:530-949-9989
Practice Address - Fax:844-644-3159
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT31544106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist