Provider Demographics
NPI:1649555475
Name:BLEVINS, HAROLD RAY (MED)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:RAY
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 N ROSE ST
Mailing Address - Street 2:
Mailing Address - City:GRANITE
Mailing Address - State:OK
Mailing Address - Zip Code:73547-9259
Mailing Address - Country:US
Mailing Address - Phone:580-535-4566
Mailing Address - Fax:
Practice Address - Street 1:317 N HUDSON ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3709
Practice Address - Country:US
Practice Address - Phone:580-482-2809
Practice Address - Fax:580-482-2820
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)