Healthcare Provider Details

I. General information

NPI: 1649442880
Provider Name (Legal Business Name): MR. MARTIN S. CHENAULT JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARTY S CHENAULT M.S.

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 HOMER CLAYTON DR.
GUNTERSVILLE AL
35976
US

IV. Provider business mailing address

2409 HOMER CLAYTON DR. SUITE 1
GUNTERSVILLE AL
35976
US

V. Phone/Fax

Practice location:
  • Phone: 256-582-3203
  • Fax: 256-582-3216
Mailing address:
  • Phone: 256-582-3216
  • Fax: 256-582-3216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCASE MANAGER
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: