Provider Demographics
NPI:1730689738
Name:BLISSFUL MIND BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:BLISSFUL MIND BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPPIT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:256-346-5505
Mailing Address - Street 1:112 PINEDA DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-8088
Mailing Address - Country:US
Mailing Address - Phone:256-655-6464
Mailing Address - Fax:
Practice Address - Street 1:207 EUSTIS AVE SE STE D
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4234
Practice Address - Country:US
Practice Address - Phone:256-346-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2745261QM0855X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health