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General NPI Number Information
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NPI Number | 1467751081
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Entity Type | Individual
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Provider Name | SALLY ANN BLEVINS LPC, MA
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Gender | Female
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 417 E EISENHOWER BLVD
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City | LOVELAND
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State | CO
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Zip | 80537-3904
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Country | US
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Telephone | 720-340-1594
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1487
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City | BERTHOUD
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State | CO
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Zip | 80513-2487
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Country | US
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Telephone | 720-340-1594
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0005972
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License Number State | CO
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