Doctor Name: | DR. IRIS H SURETTE |
NPI Number: | 1346349149 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | |
Business Practice Address: | 805 E Fremont Tombstone Unified School Dist Tombstone, AZ - 85638 |
Business Phone Number: | 5204569842 |
Business Fax Number: | 5204573720 |
Mailing Address: | Hc 1 Box 655, ELGIN |
State: | AZ |
Postal Code: | 85611 |
Phone Number: | 5204569799 |
Fax Number: | 5204561703 |
NPI Enumeration Date: | 09/21/2006 |
NPI Last Update Date: | 07/26/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |