Basic Information
| Provider Information | |||||||||
| NPI: | 1093422271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SURHIGH | ||||||||
| FirstName: | DENNIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31658 MARY ANN DR | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480925025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5869434558 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1685 BALDWIN AVE | ||||||||
| Address2: | |||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483401242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487063450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2022 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6401012312 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.