Provider Demographics
NPI:1033436969
Name:BLISS, CRANDELL W (LCPC)
Entity type:Individual
Prefix:MR
First Name:CRANDELL
Middle Name:W
Last Name:BLISS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 N LAKE ST
Mailing Address - Street 2:2ND FLOOR, SUITE 5
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1865
Mailing Address - Country:US
Mailing Address - Phone:847-566-2500
Mailing Address - Fax:
Practice Address - Street 1:510 N LAKE ST
Practice Address - Street 2:2ND FLOOR, SUITE 5
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1865
Practice Address - Country:US
Practice Address - Phone:847-566-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004080101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional