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General NPI Number Information
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NPI Number | 1306394564
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Entity Type | Organization
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Legal Business Name | EARLENE BLEVINS, MA, LPC
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Dates
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Enumeration Date | 09/16/2016
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 210 W FIFTEENTH ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-4109
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Country | US
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Telephone | 231-486-0119
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Fax | 231-486-0119
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Provider Business Mailing Address
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Address Line | 2150 S AIRPORT RD W STE C
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-4705
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Country | US
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Telephone | 231-486-0119
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Fax | 231-486-0119
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Authorized Official
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Title or Position | OWNER
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Name | EARLENE WILHELM BLEVINS
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Credential | MA LPC
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Telephone | 231-486-0119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401009566
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License Number State | MI
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