MEDICARE: MRS. VASTI HOLSTUN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4551	CO

General Provider Information

NPI Number	:	1235339417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VASTI HOLSTUN LPC

Provider Business Mailing Address
First Line	:	4251 DATE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-4907
Country	:	US
Telephone Number	:	719-310-0602
Fax Number	:

Provider Business Practice Location Address
First Line	:	6755 EARL DR STE 209
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1039
Country	:	US
Telephone Number	:	719-310-0602
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	05/15/2020

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