Provider Demographics
NPI:1679290431
Name:BLISSIT, CORRIE (AMFT)
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:BLISSIT
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 N LA FAYETTE PARK PL APT B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2920
Mailing Address - Country:US
Mailing Address - Phone:803-507-4606
Mailing Address - Fax:
Practice Address - Street 1:840 N LA FAYETTE PARK PL APT B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2920
Practice Address - Country:US
Practice Address - Phone:803-507-4606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134822106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist