Theodore Surdy, PHD LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP3385 Issued in MN

Practice address

1227 Caledonia St
Mankato, MN 56001-4329

Phone

(507) 388-8874

Fax

(507) 685-4807

NPI assigned

May 12, 2006

Last updated

Mar 16, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Surdy Psychological Services LLC

  dba Mending Roots

  • Clinical Psychologist
  • Mankato, MN
  • NPI 1225576127
  NPD Authorized official
• Mankato Marriage and Family Therapy Center PLC

  • Mental Health Counselor
  • Mankato, MN
  • NPI 1689990665
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1063463347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1227 CALEDONIA ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014329",
            "telephone_number": "507-388-8874",
            "fax_number": "507-685-4807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 CALEDONIA ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014329",
            "telephone_number": "507-388-8874",
            "fax_number": "507-685-4807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURDY",
        "first_name": "THEODORE",
        "name_prefix": "Dr.",
        "credential": "PHD LP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BXBS",
            "identifier": "06T04SU",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MINNESOTA",
            "identifier": "114945",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP28628",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED",
            "identifier": "114945",
            "state": "FM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "497823400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Supervalu Pharmacies Inc (Cub Pharmacy)
• Supervalu Pharmacies Inc (Cub Pharmacy)
• Maci Marie Surat
• Surdy Psychological Services LLC (Mending Roots)
• Taryn Surdy, LAMFT
• Theodore Nash Surdy, LPCC
• Fiona Swanson, LICSW
• Gene Earl Swanson, M.D.
• Katherine Ann Swanson, PT
• Kyle Christopher Swanson, M.D.

• Clinical Psychologist in Mankato, MN
• Providers in Mankato, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.