Provider Demographics
NPI:1801273578
Name:BLISS-WILLIAMS, ADRIANNE ROSE
Entity type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:ROSE
Last Name:BLISS-WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADRIANNE
Other - Middle Name:ROSE
Other - Last Name:BLISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1253
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96137-1253
Mailing Address - Country:US
Mailing Address - Phone:530-237-4343
Mailing Address - Fax:
Practice Address - Street 1:319 BIRCH STREET
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:CA
Practice Address - Zip Code:96137
Practice Address - Country:US
Practice Address - Phone:530-237-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF82692106H00000X
CAPSB94023388390200000X
CALMFT94903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program