NPIMap

Organization Active NPI

Blysss Behavioral Health, PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
National Provider Identifier
1932945243
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
BLYSSS BEHAVIORAL HEALTH, PLLC
Practice address
9415 S Western Ave # 206
Chicago, IL 60643-6700
Phone
(708) 941-7448
NPI assigned
Jul 5, 2024
Last updated
Sep 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Cory R Willliams, DNP
Title
Managing Partner
Phone
(844) 425-9777

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Adult Mental Health Clinic/Center 261QM0850X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

9415 S Western Ave # 206
Chicago, IL 60643-6700

Mailing address

900 W Sunset Dr Apt 613
Glenwood, IL 60425-1159
Phone (844) 425-9777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250123001966 IL Part B Supplier - Clinic/Group Practice 2062941867 Receives reassigned benefits from 5 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

9415 S Western Ave
#206
Chicago, IL 60643
Phone (708) 941-7448

9415 S Western Ave
Ste 206
Chicago, IL 60643
Phone (844) 425-9777

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1932945243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 W SUNSET DR APT 613",
            "city": "GLENWOOD",
            "state": "IL",
            "postal_code": "604251159",
            "telephone_number": "844-425-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9415 S WESTERN AVE # 206",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606436700",
            "telephone_number": "708-941-7448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLYSSS BEHAVIORAL HEALTH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-05",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A",
        "authorized_official_last_name": "WILLLIAMS",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "844-425-9777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.