Provider Demographics
NPI:1801851514
Name:BLISS, STEPHEN KENT (PSYD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KENT
Last Name:BLISS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:502-287-3958
Mailing Address - Fax:502-618-1242
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:502-287-3958
Practice Address - Fax:502-618-1242
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1335103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY89000996Medicaid
OHP00136138OtherRAILROAD MEDICARE
OH2081732Medicaid
KY0927401Medicare PIN
OHS66072Medicare UPIN
KY89000996Medicaid