Provider Demographics
NPI:1073277653
Name:BLISS PSYCHIATRY, LLC
Entity Type:Organization
Organization Name:BLISS PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-441-7944
Mailing Address - Street 1:800 4TH AVE # 1009
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-2041
Mailing Address - Country:US
Mailing Address - Phone:515-441-7944
Mailing Address - Fax:833-417-4737
Practice Address - Street 1:309 COURT AVE STE 846
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2245
Practice Address - Country:US
Practice Address - Phone:515-441-7944
Practice Address - Fax:833-417-4737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty