Basic Information
| Provider Information | |||||||||
| NPI: | 1619002987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARMENTROUT | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | P.H.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 JEFFERSON AVE FL 5 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436047102 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6045 BRIDGETOWN RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452483049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139814105 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 08/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY323 | ID | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103T00000X | P.07873 | OH | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 000020025931 | 01 | ID | REGENCE BLUE SHIELD | OTHER | N9337 | 01 | ID | BLUE CROSS | OTHER |