Healthcare Provider Details

I. General information

NPI: 1346349149
Provider Name (Legal Business Name): IRIS H SURETTE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E FREMONT TOMBSTONE UNIFIED SCHOOL DIST
TOMBSTONE AZ
85638
US

IV. Provider business mailing address

HC 1 BOX 655
ELGIN AZ
85611
US

V. Phone/Fax

Practice location:
  • Phone: 520-456-9842
  • Fax: 520-457-3720
Mailing address:
  • Phone: 520-456-9799
  • Fax: 520-456-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: