Provider Demographics
NPI:1720180391
Name:MCILVAINE, STEPHEN REED JR (MA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:REED
Last Name:MCILVAINE
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9309 BERKSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4446
Mailing Address - Country:US
Mailing Address - Phone:423-280-2643
Mailing Address - Fax:423-499-9334
Practice Address - Street 1:105 LEE PKWY W
Practice Address - Street 2:SUITE H
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6771
Practice Address - Country:US
Practice Address - Phone:423-499-9335
Practice Address - Fax:423-499-9334
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional