MEDICARE: LAURIE KERRIDGE M.A., LPC, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LH61314459	WA
2	101YP2500X	Professional Counselor	LPC.0017006	CO
3	101YP2500X	Professional Counselor	C5724	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083141444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE KERRIDGE M.A., LPC, LMHC

Provider Business Mailing Address
First Line	:	205 KEN PRATT BLVD STE 120-40
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-8993
Country	:	US
Telephone Number	:	858-449-1589
Fax Number	:	720-419-0228

Provider Business Practice Location Address
First Line	:	7175 SW BEVELAND RD STE 205
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-8665
Country	:	US
Telephone Number	:	858-449-1589
Fax Number	:	720-419-0228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2017
Last Update Date	:	08/30/2025

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