Provider Demographics
NPI:1194461343
Name:TROUT, ALEXANDER M
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:M
Last Name:TROUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1223
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-1223
Mailing Address - Country:US
Mailing Address - Phone:620-796-2206
Mailing Address - Fax:866-288-1782
Practice Address - Street 1:2029 VANESTA PL STE 20
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7401
Practice Address - Country:US
Practice Address - Phone:314-520-1461
Practice Address - Fax:866-288-1782
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional