Provider Demographics
NPI:1477508745
Name:BLISS PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:BLISS PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:502-425-6161
Mailing Address - Street 1:1601 GREY OWL CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5599
Mailing Address - Country:US
Mailing Address - Phone:502-425-6161
Mailing Address - Fax:502-425-6162
Practice Address - Street 1:1601 GREY OWL CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5599
Practice Address - Country:US
Practice Address - Phone:502-425-6161
Practice Address - Fax:502-425-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2617574Medicaid
KY89900336Medicaid
OH2617565Medicaid
OHDB9093OtherRAILROAD MEDICARE
KY9274Medicare PIN
OH2617574Medicaid