Provider Demographics
NPI:1003906066
Name:CRONSTROM, PAUL W (MA)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:W
Last Name:CRONSTROM
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:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-0281
Mailing Address - Country:US
Mailing Address - Phone:989-539-0158
Mailing Address - Fax:
Practice Address - Street 1:789 N CLARE AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-9194
Practice Address - Country:US
Practice Address - Phone:989-539-2141
Practice Address - Fax:989-539-2153
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003291103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical