Provider Demographics
NPI:1932945243
Name:BLYSSS BEHAVIORAL HEALTH, PLLC
Entity type:Organization
Organization Name:BLYSSS BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:844-425-9777
Mailing Address - Street 1:900 W SUNSET DR APT 613
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1159
Mailing Address - Country:US
Mailing Address - Phone:844-425-9777
Mailing Address - Fax:
Practice Address - Street 1:9415 S WESTERN AVE # 206
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-6700
Practice Address - Country:US
Practice Address - Phone:708-941-7448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-05
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health