Provider Demographics
NPI:1750254199
Name:DELOACH, JOSEPH F
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:DELOACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 STRASBOURG
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-8975
Mailing Address - Country:US
Mailing Address - Phone:231-590-7242
Mailing Address - Fax:
Practice Address - Street 1:1805 STRASBOURG
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49696-8975
Practice Address - Country:US
Practice Address - Phone:231-590-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001456103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist