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General NPI Number Information
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NPI Number | 1154957314
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Entity Type | Individual
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Provider Name | WILLIAM JAY BLEVINS LMFT
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Gender | Male
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 04/06/2024
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Provider Practice Location Address
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Address Line | 2564 BRANCH ST STE B5
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City | MIDDLETON
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State | WI
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Zip | 53562-2850
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Country | US
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Telephone | 608-492-0069
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Fax |
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Provider Business Mailing Address
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Address Line | 210 JUNCTION RD APT 209
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City | MADISON
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State | WI
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Zip | 53717-2673
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Country | US
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Telephone | 608-444-7105
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 908-124
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License Number State | WI
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