Healthcare Provider Details

I. General information

NPI: 1356015689
Provider Name (Legal Business Name): STEPHEN A DELMOE II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W WATER ST
CHILLICOTHEE OH
45601-2452
US

IV. Provider business mailing address

1071 TONG HOLLOW RD
BAINBRIDGE OH
45612-1500
US

V. Phone/Fax

Practice location:
  • Phone: 740-851-6493
  • Fax:
Mailing address:
  • Phone: 740-313-0569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number190246
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2507632
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: