MEDICARE: MR. PATRICK K SURRATT CM, CPSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		UT

General Provider Information

NPI Number	:	1629905658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK K SURRATT CM, CPSS

Provider Business Mailing Address
First Line	:	3896 W 10385 S
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-8731
Country	:	US
Telephone Number	:	801-413-9172
Fax Number	:

Provider Business Practice Location Address
First Line	:	3896 W 10385 S
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-8731
Country	:	US
Telephone Number	:	801-413-9172
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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