Healthcare Provider Details

I. General information

NPI: 1487990180
Provider Name (Legal Business Name): MENTAL BLISS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 12TH AVE
SEATTLE WA
98122-4410
US

IV. Provider business mailing address

818 12TH AVE
SEATTLE WA
98122-4410
US

V. Phone/Fax

Practice location:
  • Phone: 206-329-5255
  • Fax: 206-641-3231
Mailing address:
  • Phone: 206-329-5255
  • Fax: 206-641-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30007542
License Number StateWA

VIII. Authorized Official

Name: DR. KELLY W BLISS
Title or Position: MEMBER
Credential: DNP, ARNP
Phone: 206-329-5255