Provider Demographics
NPI:1306394564
Name:EARLENE BLEVINS, MA, LPC
Entity Type:Organization
Organization Name:EARLENE BLEVINS, MA, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:231-735-3256
Mailing Address - Street 1:221 GARLAND ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2271
Mailing Address - Country:US
Mailing Address - Phone:231-486-0119
Mailing Address - Fax:231-486-0119
Practice Address - Street 1:221 GARLAND ST
Practice Address - Street 2:SUITE M
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2271
Practice Address - Country:US
Practice Address - Phone:231-486-0119
Practice Address - Fax:231-486-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty