Provider Demographics
NPI:1699242404
Name:BLEVINS, BROOKE SUSANNE (LMFT-T)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:SUSANNE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:LMFT-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10881 LOWELL AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1666
Mailing Address - Country:US
Mailing Address - Phone:913-386-6889
Mailing Address - Fax:
Practice Address - Street 1:10881 LOWELL AVE STE 130
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1666
Practice Address - Country:US
Practice Address - Phone:913-386-6889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03509106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
18-59186OtherBACB