Provider Demographics
NPI:1154170769
Name:CRONE, TIMUR (MA)
Entity type:Individual
Prefix:
First Name:TIMUR
Middle Name:
Last Name:CRONE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 CENTER DR STE 408
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7908
Mailing Address - Country:US
Mailing Address - Phone:510-328-3702
Mailing Address - Fax:
Practice Address - Street 1:1314 CENTER DR STE 408
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-7908
Practice Address - Country:US
Practice Address - Phone:510-328-3702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR9211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist