Provider Demographics
NPI:1376021741
Name:BLEVINS, BRIANNE JANEE (PSYD)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:JANEE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:JANEE
Other - Last Name:HUDDLESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1128 E WEISGARBER RD STE 210
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2676
Mailing Address - Country:US
Mailing Address - Phone:864-264-2400
Mailing Address - Fax:865-588-6406
Practice Address - Street 1:1128 E WEISGARBER RD STE 210
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2676
Practice Address - Country:US
Practice Address - Phone:865-264-2400
Practice Address - Fax:865-588-6406
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN3684103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program