Provider Demographics
NPI:1134487291
Name:TROUT, CRYSTAL (MED)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:TROUT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3090 GLENFINNAN DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:45710-9462
Mailing Address - Country:US
Mailing Address - Phone:606-471-9713
Mailing Address - Fax:
Practice Address - Street 1:8680 ROCK RIFFLE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-9656
Practice Address - Country:US
Practice Address - Phone:606-471-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OHC1700413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health