Healthcare Provider Details

I. General information

NPI: 1063345478
Provider Name (Legal Business Name): BLISS AESTHETICS & WELLNESS CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2872 SECKMAN RD
IMPERIAL MO
63052-1941
US

IV. Provider business mailing address

3521 IMPERIAL HILLS DR
IMPERIAL MO
63052-2894
US

V. Phone/Fax

Practice location:
  • Phone: 314-282-5578
  • Fax: 314-987-2069
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA LINDSAY LEWIS
Title or Position: OWNER, NP
Credential: FNP
Phone: 314-282-5578