Provider Demographics
NPI:1265644439
Name:BLEVINS, WILLIAM LAFAYETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LAFAYETTE
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 SARASOTA DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-5238
Mailing Address - Country:US
Mailing Address - Phone:865-475-4179
Mailing Address - Fax:
Practice Address - Street 1:1646 RUSSELL AVE
Practice Address - Street 2:BAKER 200
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2204
Practice Address - Country:US
Practice Address - Phone:865-471-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000174101YP2500X
TN0000000049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist