Provider Demographics
NPI:1629102959
Name:BLISS, RACHEL MICHELLE (BS CADC UNDER SUP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MICHELLE
Last Name:BLISS
Suffix:
Gender:F
Credentials:BS CADC UNDER SUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:CANUTE
Mailing Address - State:OK
Mailing Address - Zip Code:73626-0152
Mailing Address - Country:US
Mailing Address - Phone:580-821-4620
Mailing Address - Fax:
Practice Address - Street 1:3080 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4323
Practice Address - Country:US
Practice Address - Phone:580-225-5136
Practice Address - Fax:580-225-5138
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)