Provider Demographics
NPI:1386988657
Name:BLEVINS, DONALD EUGENE (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:EUGENE
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:MR
Other - First Name:DON
Other - Middle Name:
Other - Last Name:BLEVINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:7519 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-4818
Mailing Address - Country:US
Mailing Address - Phone:918-955-5528
Mailing Address - Fax:
Practice Address - Street 1:7519 W 17TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-4818
Practice Address - Country:US
Practice Address - Phone:918-955-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
OK4990101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional