Healthcare Provider Details

I. General information

NPI: 1679721948
Provider Name (Legal Business Name): JOHNNY SHEALY DELOACHE LPC-MHSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 MURPHY AVE STE. 310
NASHVILLE TN
37203-1835
US

IV. Provider business mailing address

2201 MURPHY AVE STE. 310
NASHVILLE TN
37203-1835
US

V. Phone/Fax

Practice location:
  • Phone: 615-301-7000
  • Fax: 615-301-7001
Mailing address:
  • Phone: 615-301-7000
  • Fax: 615-301-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2247
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: