Healthcare Provider Details

I. General information

NPI: 1245690841
Provider Name (Legal Business Name): VESTA COLVIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10214 DACEY DR
SAINT LOUIS MO
63136-3344
US

IV. Provider business mailing address

10214 DACEY DR
SAINT LOUIS MO
63136-3344
US

V. Phone/Fax

Practice location:
  • Phone: 314-448-8983
  • Fax: 314-448-8983
Mailing address:
  • Phone: 314-448-8983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number2017043246
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2017043246
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: