Provider Demographics
NPI:1073026407
Name:SLEVIN, PATRICIA LOU (LSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOU
Last Name:SLEVIN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 RAND RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-5504
Mailing Address - Country:US
Mailing Address - Phone:317-672-2621
Mailing Address - Fax:317-866-4065
Practice Address - Street 1:1811 EXECUTIVE DR STE O
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-4361
Practice Address - Country:US
Practice Address - Phone:317-627-2568
Practice Address - Fax:317-627-2568
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33A990101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)