Healthcare Provider Details

I. General information

NPI: 1962197962
Provider Name (Legal Business Name): GAYLE ANN COLVIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 01/11/2026
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 SHAWNEE DR
CHILLICOTHEE MO
64601-3547
US

IV. Provider business mailing address

1738 WYNKOOP ST STE 303
DENVER CO
80202-1000
US

V. Phone/Fax

Practice location:
  • Phone: 166-024-7000
  • Fax:
Mailing address:
  • Phone: 720-330-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2002010916
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: