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NPI Code Detail

MEDICARE: JUSTIN CRAIG TROUT LPC

MEDICARE: JUSTIN CRAIG TROUT LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor0701008081VA

General Provider Information

NPI Number : 1386108132
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN CRAIG TROUT LPC
Provider Business Mailing Address
First Line : PO BOX 810
Second Line :
City : CEDAR BLUFF
State : VA
Zip : 24609-0810
Country : US
Telephone Number : 276-964-6702
Fax Number : 276-964-0292
Provider Business Practice Location Address
First Line : 196 CUMBERLAND RD
Second Line :
City : CEDAR BLUFF
State : VA
Zip : 24609-1137
Country : US
Telephone Number : 276-964-6702
Fax Number : 276-964-0292
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2019
Last Update Date : 01/25/2019

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Directions to “ JUSTIN CRAIG TROUT LPC” Practice Location

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