MEDICARE: MS. ELISABETH LYNN BLISS-JAYNES 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	5272	NC
2	101YS0200X	School Counselor		NC

General Provider Information

NPI Number	:	1558475046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELISABETH LYNN BLISS-JAYNES LPC

Provider Business Mailing Address
First Line	:	1454 HOUSTON MILL RD
Second Line	:
City	:	CONOVER
State	:	NC
Zip	:	28613-8504
Country	:	US
Telephone Number	:	828-256-2707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1454 HOUSTON MILL RD
Second Line	:
City	:	CONOVER
State	:	NC
Zip	:	28613-8504
Country	:	US
Telephone Number	:	828-256-2707
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	09/11/2012

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