Healthcare Provider Details

I. General information

NPI: 1205731445
Provider Name (Legal Business Name): ISABELLA KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S PARKSIDE DR
COLORADO SPRINGS CO
80910-3129
US

IV. Provider business mailing address

2933 E 148TH PL
THORNTON CO
80602-8801
US

V. Phone/Fax

Practice location:
  • Phone: 719-358-7338
  • Fax:
Mailing address:
  • Phone: 719-358-7338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0025301
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: