Provider Demographics
NPI:1447783972
Name:DR SALLY D BLISS PHD PLLC
Entity Type:Organization
Organization Name:DR SALLY D BLISS PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:DEANE
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MA, BSN
Authorized Official - Phone:425-625-6874
Mailing Address - Street 1:1740 NW MAPLE ST
Mailing Address - Street 2:STE. 210
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8127
Mailing Address - Country:US
Mailing Address - Phone:425-625-6874
Mailing Address - Fax:425-427-2477
Practice Address - Street 1:1740 NW MAPLE ST
Practice Address - Street 2:STE. 210
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8127
Practice Address - Country:US
Practice Address - Phone:425-625-6874
Practice Address - Fax:425-427-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 00002266103TA0400X, 103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TP0814X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty