Provider Demographics
NPI:1720596695
Name:TROYER, BRIAN (MAMF)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:TROYER
Suffix:
Gender:M
Credentials:MAMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 EASTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-6741
Mailing Address - Country:US
Mailing Address - Phone:859-576-5775
Mailing Address - Fax:
Practice Address - Street 1:119 S SHERRIN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3232
Practice Address - Country:US
Practice Address - Phone:502-309-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-13
Last Update Date:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172718106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY172718OtherMARRIAGE AND FAMILY THERAPIST ASSOCIATE PERMIT