Judson R Bliss, LPC, LCSW
Individual provider Active NPI Professional Counselor · Union, MO
NPI 1750587739 · NPPES record last updated Jul 8, 2024
Key facts
- NPI
- 1750587739
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 002010 (MO)
- Practice address
- 500 Clark Ave
St a
Union, MO 63084-1004 - Phone
- (636) 583-1800
- Fax
- (636) 583-0836
- NPI assigned
- Jun 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Louis Counseling, Inc
Practice addresses (Care Compare)
1349 McNutt St
Herculaneum, MO 63048-1510
Phone (636) 638-2203
500 Clark Ave
Suite a
Union, MO 63084-1065
Phone (636) 583-1800
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161207001858 | MO | Practitioner - Clinical Social Worker | 5991085011 | Reassigns benefits to 1 organization |
| I20231221001151 | MO | Practitioner - Mental Health Counselor | 5991085011 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002010 | MO | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Louis Counseling Inc | Current |
Accepting new patients | |
| Catholic Family Services Inc. | Current |
Accepting new patients |
Locations
5 Premier Dr
Ste 200
Fenton, MO 63026
Phone (314) 544-3800
1349 McNutt St
Ste C
Herculaneum, MO 63048
1349 McNutt St
Herculaneum, MO 63048
Phone (636) 638-2203
9200 Watson Rd
Ste G101
Saint Louis, MO 63126
Phone (314) 367-5500
500 Clark Ave
Ste A
Union, MO 63084
Phone (636) 583-1800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2007019560 | MO | |
| Professional Counselor | 101YP2500X | 002010 | MO | Yes |
Addresses
Primary practice location
500 Clark Ave
St a
Union, MO 63084-1004
Mailing address
5 Premier Dr Ste 200
Fenton, MO 63026-2943
Phone (314) 544-3800
Other practice location 1
1349 McNutt St
Herculaneum, MO 63048-1510
Phone (636) 638-2203
Other practice location 2
5 Premier Dr Ste 200
Fenton, MO 63026-2943
Phone (314) 544-3800
Other providers in Union, MO
- Bel Oak of Union LLC
- Hakema Berger
- George Howard Bergevin
- Kimberly L Bickel
- Allison E Blake
- Alicia S. Bolzenius
- Marcella L Bolzenius
- Katrina Boogerd
- Jamie Marie Borgmann
- Caitlin Elizabeth Bright
All providers in Union, MO · Professional Counselor in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.