Healthcare Provider Details

I. General information

NPI: 1154141380
Provider Name (Legal Business Name): STEPHANIE JULIA-SURIANO REGISTERED ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 NE COURTNEY DR
BEND OR
97701-7685
US

IV. Provider business mailing address

257 S PINE ST
SISTERS OR
97759-1680
US

V. Phone/Fax

Practice location:
  • Phone: 541-719-8545
  • Fax: 888-280-0531
Mailing address:
  • Phone: 541-719-8545
  • Fax: 888-280-0531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: