Provider Demographics
NPI:1669505806
Name:BLEVINS, EARLENE WILHELM (LPC)
Entity Type:Individual
Prefix:MS
First Name:EARLENE
Middle Name:WILHELM
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 GARLAND ST
Mailing Address - Street 2:STE. M
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2271
Mailing Address - Country:US
Mailing Address - Phone:231-486-0119
Mailing Address - Fax:231-486-0119
Practice Address - Street 1:221 GARLAND ST
Practice Address - Street 2:STE. M
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2271
Practice Address - Country:US
Practice Address - Phone:231-486-0119
Practice Address - Fax:231-486-0119
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009566101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional