Provider Demographics
NPI:1619360500
Name:KRUM, KEVIN E (MA LLP)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:KRUM
Suffix:
Gender:M
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2981 E STERNBERG RD
Mailing Address - Street 2:
Mailing Address - City:FRUITPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49415-8625
Mailing Address - Country:US
Mailing Address - Phone:231-578-9664
Mailing Address - Fax:616-336-2475
Practice Address - Street 1:2981 E STERNBERG RD
Practice Address - Street 2:
Practice Address - City:FRUITPORT
Practice Address - State:MI
Practice Address - Zip Code:49415-8625
Practice Address - Country:US
Practice Address - Phone:231-578-9664
Practice Address - Fax:616-336-2475
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011184103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling