Provider Demographics
NPI:1356077754
Name:BLISS PSYCHOTHERAPY BY DR. VAKILI INC.
Entity Type:Organization
Organization Name:BLISS PSYCHOTHERAPY BY DR. VAKILI INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VESAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAKILI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, PSYD
Authorized Official - Phone:949-300-6608
Mailing Address - Street 1:106 JAYBIRD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3518
Mailing Address - Country:US
Mailing Address - Phone:916-945-2739
Mailing Address - Fax:
Practice Address - Street 1:106 JAYBIRD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3518
Practice Address - Country:US
Practice Address - Phone:916-945-2739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1851754998OtherBLUE CROSS, BLUE SHIELD, AETNA