Provider Demographics
NPI:1679721948
Name:DELOACHE, JOHNNY SHEALY (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:SHEALY
Last Name:DELOACHE
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 MURPHY AVE
Mailing Address - Street 2:STE. 310
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1835
Mailing Address - Country:US
Mailing Address - Phone:615-301-7000
Mailing Address - Fax:615-301-7001
Practice Address - Street 1:2201 MURPHY AVE
Practice Address - Street 2:STE. 310
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1835
Practice Address - Country:US
Practice Address - Phone:615-301-7000
Practice Address - Fax:615-301-7001
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2247101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional