Healthcare Provider Details

I. General information

NPI: 1023511672
Provider Name (Legal Business Name): TROUTMAN COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21321 E OCOTILLO RD STE 113
QUEEN CREEK AZ
85142-5994
US

IV. Provider business mailing address

PO BOX 1972
QUEEN CREEK AZ
85142-1842
US

V. Phone/Fax

Practice location:
  • Phone: 480-465-9841
  • Fax:
Mailing address:
  • Phone: 480-465-9841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLCSW-13890
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberLCSW-13890
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberLCSW-13890
License Number StateAZ

VIII. Authorized Official

Name: JEFFREY MICHAEL TROUTMAN
Title or Position: OWNER/CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 480-465-9841