Basic Information
| Provider Information | |||||||||
| NPI: | 1982904132 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRANENDONK | ||||||||
| FirstName: | SHELDON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MA, LLPC, CAAC, IMH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 506 | ||||||||
| Address2: | |||||||||
| City: | PICKFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497740506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9066472217 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 416 N M 129 | ||||||||
| Address2: | |||||||||
| City: | PICKFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497749204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9066472217 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2010 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6401011522 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.