Provider Demographics
NPI:1548748445
Name:DELAVERGNE, LUKE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:LUKE
Middle Name:
Last Name:DELAVERGNE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4156 MEADOW VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-8197
Mailing Address - Country:US
Mailing Address - Phone:615-549-5033
Mailing Address - Fax:
Practice Address - Street 1:210 25TH AVE N STE 1220
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1606
Practice Address - Country:US
Practice Address - Phone:615-549-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN83-1412647OtherEMPLOYEE IDENTIFICATION NUMBER