Provider Demographics
NPI:1518564947
Name:BLEVINS, MARGARET L (TLLP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21769 MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1453
Mailing Address - Country:US
Mailing Address - Phone:734-307-6382
Mailing Address - Fax:
Practice Address - Street 1:32770 GRAND RIVER AVE STE 206B
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3159
Practice Address - Country:US
Practice Address - Phone:734-307-6382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009101103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist