Provider Demographics
NPI:1346701240
Name:BASIC BLISS LIFE COACHING AND COUNSELING, LLC
Entity Type:Organization
Organization Name:BASIC BLISS LIFE COACHING AND COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:267-587-6722
Mailing Address - Street 1:150 N RADNOR CHESTER RD STE F200
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5245
Mailing Address - Country:US
Mailing Address - Phone:267-587-6722
Mailing Address - Fax:
Practice Address - Street 1:150 N RADNOR CHESTER RD STE F200
Practice Address - Street 2:
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5245
Practice Address - Country:US
Practice Address - Phone:267-587-6722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1538410212Medicaid