Healthcare Provider Details

I. General information

NPI: 1619633492
Provider Name (Legal Business Name): KATE BLISSMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E COLORADO BLVD STE 560
PASADENA CA
91106-2380
US

IV. Provider business mailing address

505 N TUSTIN AVE STE 265
SANTA ANA CA
92705-3775
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-6780
  • Fax: 818-241-6853
Mailing address:
  • Phone: 714-367-6835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number164173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: