Provider Demographics
NPI:1043382237
Name:BLISS, DAVID J (PSYD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BLISS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1614
Mailing Address - Country:US
Mailing Address - Phone:606-886-8572
Mailing Address - Fax:606-886-4433
Practice Address - Street 1:104 S FRONT AVE
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1614
Practice Address - Country:US
Practice Address - Phone:606-886-8572
Practice Address - Fax:606-886-4433
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1019103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000213213OtherANTHEM BCBS
KY0675616Medicare ID - Type Unspecified
KY0371317Medicare ID - Type Unspecified
KY0675716Medicare ID - Type Unspecified
KY0662419Medicare ID - Type Unspecified
KY0675416Medicare ID - Type Unspecified
KY0653317Medicare ID - Type Unspecified
KY000000213213OtherANTHEM BCBS
KY1266944Medicare ID - Type Unspecified
KY0366422Medicare ID - Type Unspecified
KY0675516Medicare ID - Type Unspecified