Edward Kenneth Surridge, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

LF60920533 Issued in WA

Practice address

755 Winslow Way E Ste 303
Bainbridge Island, WA 98110-2483

Phone

(209) 429-5360

Fax

(442) 615-7422

NPI assigned

Jul 8, 2010

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

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

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625529600000",
    "number": "1508178443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 WINSLOW WAY E STE 303",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981102483",
            "telephone_number": "360-209-4295",
            "fax_number": "442-615-7422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 WINSLOW WAY E STE 303",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981102483",
            "telephone_number": "209-429-5360",
            "fax_number": "442-615-7422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURRIDGE",
        "first_name": "EDWARD",
        "middle_name": "KENNETH",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-08",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "MG60116131",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "LF60920533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Bainbridge Island, WA
• Providers in Bainbridge Island, WA by specialty
• Marriage & Family Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2021; 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.