Provider Demographics
NPI:1184978595
Name:ARMENTROUT, BEN L (BA,LAC)
Entity type:Individual
Prefix:MR
First Name:BEN
Middle Name:L
Last Name:ARMENTROUT
Suffix:
Gender:M
Credentials:BA,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EAGLE FEATHER STREET
Mailing Address - Street 2:BOARD OF HEALTH
Mailing Address - City:LAME DEER
Mailing Address - State:MT
Mailing Address - Zip Code:59043
Mailing Address - Country:US
Mailing Address - Phone:406-477-6722
Mailing Address - Fax:406-477-6727
Practice Address - Street 1:100 EAGLE FEATHER STREET
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043
Practice Address - Country:US
Practice Address - Phone:406-477-6722
Practice Address - Fax:406-477-6727
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT537101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT537Medicaid