Provider Demographics
NPI:1518553007
Name:SURLES, DESHIRE SHEVTTE (QBHP)
Entity Type:Individual
Prefix:
First Name:DESHIRE
Middle Name:SHEVTTE
Last Name:SURLES
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5291 COLONY DR N
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-7197
Mailing Address - Country:US
Mailing Address - Phone:989-702-2082
Mailing Address - Fax:989-355-1398
Practice Address - Street 1:5291 COLONY DR N
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7197
Practice Address - Country:US
Practice Address - Phone:989-702-2082
Practice Address - Fax:989-355-1398
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst