Provider Demographics
NPI:1215232053
Name:VESTAL, STEVEN M (LPC, LCDC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:M
Last Name:VESTAL
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13845 CORPUS CHRISTI ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3961
Mailing Address - Country:US
Mailing Address - Phone:713-637-8228
Mailing Address - Fax:713-344-0431
Practice Address - Street 1:13845 CORPUS CHRISTI ST
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3961
Practice Address - Country:US
Practice Address - Phone:713-637-8228
Practice Address - Fax:713-344-0431
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11274101YA0400X
TX68871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX303664201Medicaid
TX12162756OtherCAQH