Basic Information
| Provider Information | |||||||||
| NPI: | 1649442880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHENAULT | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHENAULT | ||||||||
| OtherFirstName: | MARTY | ||||||||
| OtherMiddleName: | S | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.S. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2409 HOMER CLAYTON DR. | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | GUNTERSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565823216 | ||||||||
| FaxNumber: | 2565823216 | ||||||||
| Practice Location | |||||||||
| Address1: | 2409 HOMER CLAYTON DR. | ||||||||
| Address2: | |||||||||
| City: | GUNTERSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565823203 | ||||||||
| FaxNumber: | 2565823216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2008 | ||||||||
| LastUpdateDate: | 07/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | CASE MANAGER | N | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.