Nicole Diane Bliss
Individual provider Active NPI Marriage & Family Therapist · Azusa, CA
NPI 1205488236 · NPPES record last updated Feb 18, 2025
Key facts
- NPI
- 1205488236
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 142725 (CA)
- Practice address
- 777 E Alosta Ave
Azusa, CA 91702-3102 - Phone
- (657) 221-9592
- NPI assigned
- Jul 10, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 142725 | CA | MD | Marriage & Family Therapist |
| 15083 | CA | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 15083 | CA | |
| Marriage & Family Therapist | 106H00000X | 142725 | CA | Yes |
Addresses
Primary practice location
777 E Alosta Ave
Azusa, CA 91702-3102
Mailing address
675 N Euclid St # 310
Anaheim, CA 92801-4639
Phone (657) 221-9592
Other practice location 1
12440 Firestone Blvd Ste 310
Norwalk, CA 90650-4397
Phone (562) 321-9900
Other providers in Azusa, CA
- Rhonda Renae Beckwith
- Richard Joseph Bennett
- Patrick Ryan Bergeron
- Rajiv H Bhuva
- Bina a Kamdar MD, Inc.
- Viviana Boiso
- Stephanie Boles
- Shariar Borbor
- Cecilia Borja
- Nicole Brandt
All providers in Azusa, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.