Healthcare Provider Details

I. General information

NPI: 1760233654
Provider Name (Legal Business Name): BRYCE A ARMANTROUT LCDC III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 VICTORY PKWY
CINCINNATI OH
45206-1754
US

IV. Provider business mailing address

2600 VICTORY PKWY
CINCINNATI OH
45206-1395
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-7747
  • Fax:
Mailing address:
  • Phone: 513-751-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.162632
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberW.2400401
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: