Healthcare Provider Details

I. General information

NPI: 1427132463
Provider Name (Legal Business Name): MAREN BLEVINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAREN C SHEESE

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N BROADWAY
PERU IN
46970-1070
US

IV. Provider business mailing address

2355 S BUSINESS 31
PERU IN
46970-8985
US

V. Phone/Fax

Practice location:
  • Phone: 574-722-5151
  • Fax: 574-739-1414
Mailing address:
  • Phone: 574-722-5151
  • Fax: 574-739-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005356A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: