Provider Demographics
NPI:1295350635
Name:TROUT, AMY WEAVER (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:WEAVER
Last Name:TROUT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 BRADFORD RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8804
Mailing Address - Country:US
Mailing Address - Phone:239-209-5046
Mailing Address - Fax:
Practice Address - Street 1:2110 CHIQUITA BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-3247
Practice Address - Country:US
Practice Address - Phone:239-772-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor