Provider Demographics
NPI:1942638713
Name:SUROVIK, TRISH (LCDC, LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:TRISH
Middle Name:
Last Name:SUROVIK
Suffix:
Gender:F
Credentials:LCDC, LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77418-1620
Mailing Address - Country:US
Mailing Address - Phone:979-716-4673
Mailing Address - Fax:
Practice Address - Street 1:740 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:TX
Practice Address - Zip Code:77418-1620
Practice Address - Country:US
Practice Address - Phone:979-716-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11578101YA0400X
TX68718101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)