Patrick Ethan Ridge

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

140069 Issued in CA

Practice address

1777 Buckman Springs Rd
Campo, CA 91906-2022

Phone

(619) 478-5696

Fax

(619) 478-2404

NPI assigned

Jul 23, 2018

Last updated

Jul 19, 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Childnet Youth and Family Services, Inc.

  • Community/Behavioral Health Agency
  • Riverside, CA
  • NPI 1275991465
  NPD (past)
• San Diego Freedom Ranch, Inc.

  • Substance Abuse Rehabilitation Facility
  • Campo, CA
  • NPI 1093937591
  NPD (past)

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

{
    "created_epoch": "1532304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1306323381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 BUCKMAN SPRINGS RD",
            "city": "CAMPO",
            "state": "CA",
            "postal_code": "919062022",
            "telephone_number": "619-478-5696",
            "fax_number": "619-478-2404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 BUCKMAN SPRINGS RD",
            "city": "CAMPO",
            "state": "CA",
            "postal_code": "919062022",
            "telephone_number": "619-478-5696",
            "fax_number": "619-478-2404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1950 Market St",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925011720",
            "country_code": "US",
            "telephone_number": "951-530-5900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "790 E Bonita Ave",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917671906",
            "country_code": "US",
            "telephone_number": "909-625-7207 x3440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIDGE",
        "first_name": "PATRICK",
        "middle_name": "ETHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-23",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "140069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Matthew Perea, CADC I
• Kyle Porter
• Carlos Alberto Ramirez, RADT
• Giselle Ramirez, RADT
• Ronald Reza, CMPSS
• Matthew W Rogers, DO
• Luzviminda Dulnuan Saidro, M.D.
• San Diego Freedom Ranch, Inc.
• Jonathan Sandoval, CCMA
• Christopher David Serna, CPSS

• Marriage & Family Therapist in Campo, CA
• Providers in Campo, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 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.