Basic Information
| Provider Information | |||||||||
| NPI: | 1700365061 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELOTELLE | ||||||||
| FirstName: | STEVE | ||||||||
| MiddleName: | GUTHERIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.A | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DELOTELLE | ||||||||
| OtherFirstName: | STEVE | ||||||||
| OtherMiddleName: | GUTHERIE | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6142 BITTERSWEET LN | ||||||||
| Address2: | |||||||||
| City: | MC DONALD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373532201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237105977 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6110 SHALLOWFORD RD | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374211894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235094128 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2018 | ||||||||
| LastUpdateDate: | 08/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.