Healthcare Provider Details

I. General information

NPI: 1629522149
Provider Name (Legal Business Name): ISABELLA KOTNOUR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 E 12TH AVE
DENVER CO
80203-2610
US

IV. Provider business mailing address

709 E 12TH AVE
DENVER CO
80203-2610
US

V. Phone/Fax

Practice location:
  • Phone: 303-830-8805
  • Fax: 303-830-8918
Mailing address:
  • Phone: 303-830-8805
  • Fax: 303-830-8918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6376
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: