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Individual

MR. GRANT MATTHEW COLVIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
7750 CLAYTON RD, SUITE 304, SAINT LOUIS, MO 63117-1353
(314) 727-1118
Mailing address
7750 CLAYTON RD, SUITE 304, SAINT LOUIS, MO 63117-1353
(314) 727-1118

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
005500
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
117597
BLUE CROSS BLUE SHIELD
MO
Enumeration date
08/05/2006
Last updated
07/08/2007
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