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General NPI Number Information
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NPI Number | 1023511672
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Entity Type | Organization
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Legal Business Name | TROUTMAN COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 03/09/2018
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Provider Practice Location Address
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Address Line | 21321 E OCOTILLO RD STE 113
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-5994
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Country | US
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Telephone | 480-465-9841
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1972
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-1842
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Country | US
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Telephone | 480-465-9841
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL SOCIAL WORKER
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Name | JEFFREY MICHAEL TROUTMAN
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Credential | LCSW
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Telephone | 480-465-9841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | LCSW-13890
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | LCSW-13890
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCSW-13890
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License Number State | AZ
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