Active NPI
Stephen Reed McIlvaine Jr., M.A.
- Professional Counselor
- Chattanooga, TN
National Provider Identifier
1720180391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 560
- Practice address
- 105 Lee Pkwy W
Suite H
Chattanooga, TN 37421-6771 - Phone
- (423) 499-9335
- Fax
- (423) 499-9334
- NPI assigned
- Sep 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 560 | TN | Primary |
Addresses
Primary practice location
105 Lee Pkwy W
Suite H
Chattanooga, TN 37421-6771
Mailing address
9309 Berkshire Cir
Chattanooga, TN 37421-4446
Phone (423) 280-2643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 7, 2024 through Mar 7, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 560 | TN | MD | Acupuncturist |
| 129 | TN | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720180391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9309 BERKSHIRE CIR",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374214446",
"telephone_number": "423-280-2643",
"fax_number": "423-499-9334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 LEE PKWY W",
"address_2": "SUITE H",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374216771",
"telephone_number": "423-499-9335",
"fax_number": "423-499-9334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCILVAINE",
"first_name": "STEPHEN",
"middle_name": "REED",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "M.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TN",
"license": "560",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.