Provider Demographics
NPI:1346607405
Name:TROUTT, DOLORI JEAN (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:DOLORI
Middle Name:JEAN
Last Name:TROUTT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:DJ
Other - Middle Name:
Other - Last Name:TROUTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:431 E STATE HIGHWAY 114 FL 1
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4412
Mailing Address - Country:US
Mailing Address - Phone:502-744-6919
Mailing Address - Fax:
Practice Address - Street 1:431 E STATE HIGHWAY 114 FL 1
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4412
Practice Address - Country:US
Practice Address - Phone:502-446-9197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174049101YA0400X, 101YP2500X
KY277015101YP2500X
TX92206101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100490380Medicaid