Provider Demographics
NPI:1043730765
Name:BLISS ADVANCED CLINICAL SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:BLISS ADVANCED CLINICAL SOLUTIONS, PLLC
Other - Org Name:BLISS BEHAVIORAL HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:SYLVESTER
Authorized Official - Middle Name:O
Authorized Official - Last Name:NWOSU
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:973-964-4595
Mailing Address - Street 1:2422 FAIRBREEZE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2422 FAIRBREEZE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5102
Practice Address - Country:US
Practice Address - Phone:973-964-4595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)