Provider Demographics
NPI:1811692924
Name:BLISS, SARAH LYN (LPC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYN
Last Name:BLISS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 BUSH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4180
Mailing Address - Country:US
Mailing Address - Phone:630-880-3305
Mailing Address - Fax:
Practice Address - Street 1:28 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2111
Practice Address - Country:US
Practice Address - Phone:630-534-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178018872101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional