Provider Demographics
NPI:1508178443
Name:SURRIDGE, EDWARD KENNETH (LMFT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:KENNETH
Last Name:SURRIDGE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 WINSLOW WAY E STE 303
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2483
Mailing Address - Country:US
Mailing Address - Phone:360-209-4295
Mailing Address - Fax:442-615-7422
Practice Address - Street 1:755 WINSLOW WAY E STE 303
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2483
Practice Address - Country:US
Practice Address - Phone:209-429-5360
Practice Address - Fax:442-615-7422
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60116131106H00000X
WALF60920533106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist