Provider Demographics
NPI:1508019894
Name:BLEVINS, KELLI (BA)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 993
Mailing Address - Street 2:
Mailing Address - City:COULEE CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99115-0993
Mailing Address - Country:US
Mailing Address - Phone:506-765-9239
Mailing Address - Fax:509-765-1582
Practice Address - Street 1:840 E PLUM ST
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1874
Practice Address - Country:US
Practice Address - Phone:509-765-9239
Practice Address - Fax:509-765-1582
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health