Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY 00002266 | WA |
N | 103T00000X | Psychologist | PY 00002266 | WA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY 00002266 | WA |
Y | 103G00000X | Clinical Psychologist | PY 00002266 | WA |
Y | 103TC0700X | Clinical Psychologist | PY 00002266 | WA |
N | 103TC1900X | Counseling Psychologist | PY 00002266 | WA |
N | 103TF0000X | Family Psychologist | PY 00002266 | WA |
NPI | 1205973633 |
---|---|
Provider Name | Ms. Sally Deane Bliss |
First Address | Issaquah, WA 98027-8127 |
Second Address | Issaquah, WA 98027-8127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 13/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PY 00002266 | PSYCHOLOGIST LICENSE (01) | WA |