Provider Demographics
NPI:1154957314
Name:BLEVINS, WILLIAM JAY (LMFT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JAY
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 JUNCTION RD APT 209
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2673
Mailing Address - Country:US
Mailing Address - Phone:608-444-7105
Mailing Address - Fax:
Practice Address - Street 1:2564 BRANCH ST STE B5
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2850
Practice Address - Country:US
Practice Address - Phone:608-492-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI908-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist