Provider Demographics
NPI:1649442880
Name:CHENAULT, MARTIN S JR
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:S
Last Name:CHENAULT
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MARTY
Other - Middle Name:S
Other - Last Name:CHENAULT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:2409 HOMER CLAYTON DR.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976
Mailing Address - Country:US
Mailing Address - Phone:256-582-3216
Mailing Address - Fax:256-582-3216
Practice Address - Street 1:2409 HOMER CLAYTON DR.
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976
Practice Address - Country:US
Practice Address - Phone:256-582-3203
Practice Address - Fax:256-582-3216
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASE MANAGER171M00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator