Provider Demographics
NPI:1265728364
Name:SURLEY, KENNETH RICHARD (CMFT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RICHARD
Last Name:SURLEY
Suffix:
Gender:M
Credentials:CMFT
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28116 ROYAL ASCOT DR
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4652
Mailing Address - Country:US
Mailing Address - Phone:210-854-9819
Mailing Address - Fax:210-404-9466
Practice Address - Street 1:1380 PANTHEON WAY # 310
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2288
Practice Address - Country:US
Practice Address - Phone:210-697-8191
Practice Address - Fax:210-404-9466
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health