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Randall Edward Surque
Counselor in Jackson, Michigan
NPI 1447726146

Randall Edward Surque is a Counselor based in Jackson, MI. Randall Edward Surque practices in Jackson, MI. The NPI Number for Randall Edward Surque is 1447726146 and holds a License No. 6401016161 (Michigan).

The current practice location address for Randall Edward Surque is 1200 N West Ave, Jackson, MI and can be reached out via phone at 517-789-1200 and via fax at 517-789-1276.

Location: 1200 N West Ave, Jackson, MI, 49202-2179
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1447726146
Provider Name
Randall Edward Surque
Credential
Provider Entity Type
Individual
Gender
Male
Address
1200 N West Ave, Jackson, MI, 49202-2179
Phone Number
517-789-1200
Fax Number
517-789-1276
Provider Enumeration Date
10/19/2018
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
6401016161 01 MI STATE LICENSE
institution
Provider Business Practice Location Address Details
Address
1200 N West Ave
City
Jackson
State
Michigan
Zip
49202-2179
Phone Number
517-789-1200
Fax Number
517-789-1276
person
Provider Business Mailing Address Details
Address
1200 N West Ave
City
Jackson
State
Michigan
Zip
49202-2179
Phone Number
517-789-1200
Fax Number
517-789-1276
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
-
Taxonomy
101Y00000X
License No.
6401016161 (Michigan)
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
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