Individual provider Active NPI

Kenyatta Cole

  • Professional Counselor
  • Des Peres, MO
National Provider Identifier
1881207264
Registry record updated Aug 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Practice address
13100 Manchester Rd Ste 155
Des Peres, MO 63131-1703
Phone
(314) 394-1171
NPI assigned
Aug 26, 2020
Last updated
Aug 7, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X NU Primary
Behavior Technician 106S00000X NU

Addresses

Primary practice location

13100 Manchester Rd Ste 155
Des Peres, MO 63131-1703

Mailing address

13100 Manchester Rd Ste 155
Des Peres, MO 63131-1703
Phone (314) 394-1171

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251120002169 MO Practitioner - Mental Health Counselor 6406348101 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

12800 Corporate Hill Dr
Saint Louis, MO 63131-1833

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care St Louis CurrentSince Oct 13, 2025 Accepting new patients
SSM Health Care St. Louis CurrentSince Oct 13, 2025 Accepting new patients
Foundations for Change, LLC Professional CurrentSince Nov 19, 2024 Accepting new patients

Locations

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

12355 De Paul Dr
Ste 150
Bridgeton, MO 63044
Phone (314) 344-7153

12355 De Paul Dr
Ste 160
Bridgeton, MO 63044
Phone (314) 344-7101

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

13100 Manchester Rd
Ste 155
Saint Louis, MO 63131
Phone (314) 394-1171

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754524800000",
    "number": "1881207264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13100 MANCHESTER RD STE 155",
            "city": "DES PERES",
            "state": "MO",
            "postal_code": "631311703",
            "telephone_number": "314-394-1171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13100 MANCHESTER RD STE 155",
            "city": "DES PERES",
            "state": "MO",
            "postal_code": "631311703",
            "telephone_number": "314-394-1171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLE",
        "first_name": "KENYATTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-26",
        "last_updated": "2025-08-07",
        "certification_date": "2025-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Peres, MO

Sources for this page

Verify at the official NPI Registry.