Provider Demographics
NPI:1467751081
Name:BLEVINS, SALLY ANN (LPC, MA)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:BLEVINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, MA
Mailing Address - Street 1:PO BOX 1487
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-2487
Mailing Address - Country:US
Mailing Address - Phone:720-340-1594
Mailing Address - Fax:
Practice Address - Street 1:417 E EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3904
Practice Address - Country:US
Practice Address - Phone:720-340-1594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0005972101YP2500X
TX64878101Y00000X, 101YM0800X, 101YP2500X
COCO5972101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health