Healthcare Provider Details

I. General information

NPI: 1023920303
Provider Name (Legal Business Name): BAINBRIDGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 NE FERN ST
SUQUAMISH WA
98392-9539
US

IV. Provider business mailing address

6431 NE FERN ST
SUQUAMISH WA
98392-9539
US

V. Phone/Fax

Practice location:
  • Phone: 657-333-5464
  • Fax:
Mailing address:
  • Phone: 657-333-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRITANIA ISON
Title or Position: PRINCIPAL
Credential: SUDP, LMFTA, LMHCA
Phone: 657-333-5464