| Doctor Name: | EVONNA SURRETTE |
| NPI Number: | 1003242652 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 9959 |
| Business Practice Address: | 130 Calo Ln Lake Ozark, MO - 650499208 |
| Business Phone Number: | 5737467311 |
| Business Fax Number: | 5733652224 |
| Mailing Address: | 130 Calo Ln, LAKE OZARK |
| State: | MO |
| Postal Code: | 650499208 |
| Phone Number: | 5737467311 |
| Fax Number: | 5733652224 |
| NPI Enumeration Date: | 09/15/2013 |
| NPI Last Update Date: | 02/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 9959 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NE |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |