Individual
ETHAN BLISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
340 PARK AVE, FREDERICK, MD 21701-4931
(301) 663-1683
(301) 663-3792
Mailing address
121 MANDA DR, MIDDLETOWN, MD 21769-7853
(301) 508-0102
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39001937A
IN
101YM0800X
Mental Health Counselor
MH 7447
FL
103T00000X
Psychologist
20042437A
IN
103TC0700X
Clinical Psychologist
Primary
04888
MD
Other
Enumeration date
02/28/2007
Last updated
11/22/2010
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