MEDICARE: MS. ABIGAIL LOUISE BLISS MA ATRBC LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2112	OK

General Provider Information

NPI Number	:	1689760829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ABIGAIL LOUISE BLISS MA ATRBC LPC

Provider Business Mailing Address
First Line	:	650 S PEORIA
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74120-4429
Country	:	US
Telephone Number	:	918-587-9471
Fax Number	:	918-560-0137

Provider Business Practice Location Address
First Line	:	650 S PEORIA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74120-4429
Country	:	US
Telephone Number	:	918-587-9471
Fax Number	:	918-560-0137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	08/04/2024

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