Healthcare Provider Details

I. General information

NPI: 1053036657
Provider Name (Legal Business Name): AMY SURLS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4144 N CENTRAL EXPY STE 850
DALLAS TX
75204-3226
US

IV. Provider business mailing address

9191 GARLAND RD APT 7310
DALLAS TX
75218-3806
US

V. Phone/Fax

Practice location:
  • Phone: 972-865-8782
  • Fax: 972-499-6935
Mailing address:
  • Phone: 615-512-8056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: