Provider Demographics
NPI:1316032717
Name:BLEVINS, HOWARD P (PHD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:P
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 1:2100 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-8556
Mailing Address - Country:US
Mailing Address - Phone:337-261-0734
Mailing Address - Fax:337-261-5471
Practice Address - Street 1:2100 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-8556
Practice Address - Country:US
Practice Address - Phone:337-261-0734
Practice Address - Fax:337-261-5471
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA654103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical