Provider Demographics
NPI:1215493192
Name:SURBROOK, TAMMY EILEEN
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:EILEEN
Last Name:SURBROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8425
Mailing Address - Country:US
Mailing Address - Phone:541-772-2763
Mailing Address - Fax:541-734-3164
Practice Address - Street 1:777 MURPHY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8425
Practice Address - Country:US
Practice Address - Phone:541-772-2763
Practice Address - Fax:541-734-3164
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information