Healthcare Provider Details

I. General information

NPI: 1639082779
Provider Name (Legal Business Name): ISABELLA CLEGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 W SOUTH BOULDER RD STE 6
LOUISVILLE CO
80027-1192
US

IV. Provider business mailing address

335 W SOUTH BOULDER RD STE 6
LOUISVILLE CO
80027-1192
US

V. Phone/Fax

Practice location:
  • Phone: 720-295-2683
  • Fax:
Mailing address:
  • Phone: 720-295-2683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0023959
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: