Provider Demographics
NPI:1265765713
Name:CRONIN, MICHAEL (LPC, CGACI, CADCI)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CRONIN
Suffix:
Gender:M
Credentials:LPC, CGACI, CADCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7734 N DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-5510
Mailing Address - Country:US
Mailing Address - Phone:503-866-7022
Mailing Address - Fax:503-690-0678
Practice Address - Street 1:3000 NE STUCKI AVE STE 230
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7328
Practice Address - Country:US
Practice Address - Phone:503-980-1382
Practice Address - Fax:503-690-0678
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)