Provider Demographics
NPI:1851515340
Name:BLEVINS, KATHERINE SUE (LSCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:SUE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:4105 W 6TH ST
Mailing Address - Street 2:STE B10
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4696
Mailing Address - Country:US
Mailing Address - Phone:785-840-0374
Mailing Address - Fax:785-424-7684
Practice Address - Street 1:4105 W 6TH ST
Practice Address - Street 2:STE B10
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4696
Practice Address - Country:US
Practice Address - Phone:785-840-0374
Practice Address - Fax:785-424-7684
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS37961041C0700X
KS142101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)