Provider Demographics
NPI:1083439079
Name:SURMEYER, SHANDRAY (CRC, COUNSELOR INTER)
Entity type:Individual
Prefix:
First Name:SHANDRAY
Middle Name:
Last Name:SURMEYER
Suffix:
Gender:F
Credentials:CRC, COUNSELOR INTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E. COEUR D'ALENE AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-717-1239
Mailing Address - Fax:208-620-2306
Practice Address - Street 1:211 E. COEUR D'ALENE AVE
Practice Address - Street 2:
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-717-1239
Practice Address - Fax:208-620-2306
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9961975101Y00000X
ID323964225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101Y00000XBehavioral Health & Social Service ProvidersCounselor