=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801273578
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIANNE ROSE BLISS-WILLIAMS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2015
-----------------------------------------------------
Last Update Date | 08/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 319 BIRCH STREET
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-237-4343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1253
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96137-1253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-237-4343
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | IMF82692
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | PSB94023388
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT94903
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------