Provider Demographics
NPI:1508478082
Name:SURRELL, TAHONNA LATREISE (MS)
Entity Type:Individual
Prefix:
First Name:TAHONNA
Middle Name:LATREISE
Last Name:SURRELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 E CHANDLER BLVD UNIT 1034
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7281
Mailing Address - Country:US
Mailing Address - Phone:520-280-6272
Mailing Address - Fax:
Practice Address - Street 1:3236 E CHANDLER BLVD UNIT 1034
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7281
Practice Address - Country:US
Practice Address - Phone:520-280-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)