Provider Demographics
NPI:1134984917
Name:SURF, SAND AND SAGE, PLLC
Entity type:Organization
Organization Name:SURF, SAND AND SAGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:E PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:541-556-8290
Mailing Address - Street 1:1002 39TH AVE SW STE 208
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3805
Mailing Address - Country:US
Mailing Address - Phone:253-317-1737
Mailing Address - Fax:253-446-6248
Practice Address - Street 1:1002 39TH AVE SW STE 208
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3805
Practice Address - Country:US
Practice Address - Phone:253-317-1737
Practice Address - Fax:253-697-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health