Provider Demographics
NPI:1497525265
Name:ARMENTROUT, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ARMENTROUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19888 E SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-3332
Mailing Address - Country:US
Mailing Address - Phone:480-282-0132
Mailing Address - Fax:
Practice Address - Street 1:510 E MOELLER ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2612
Practice Address - Country:US
Practice Address - Phone:928-420-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAMFT-08038T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist