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General NPI Number Information
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NPI Number | 1720180391
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Entity Type | Individual
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Provider Name | STEPHEN REED MCILVAINE JR. M.A.
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Gender | Male
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 105 LEE PKWY W SUITE H
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City | CHATTANOOGA
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State | TN
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Zip | 37421-6771
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Country | US
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Telephone | 423-499-9335
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Fax | 423-499-9334
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Provider Business Mailing Address
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Address Line | 9309 BERKSHIRE CIR
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City | CHATTANOOGA
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State | TN
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Zip | 37421-4446
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Country | US
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Telephone | 423-280-2643
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Fax | 423-499-9334
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 560
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License Number State | TN
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