Provider Demographics
NPI:1457731903
Name:BLEVINS, CHRISTY ALEENE (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:ALEENE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:ALEENE
Other - Last Name:TALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 ELM ST
Mailing Address - Street 2:APT 32
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 ELM ST
Practice Address - Street 2:APT 32
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2232
Practice Address - Country:US
Practice Address - Phone:512-925-5486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-30
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist