Provider Demographics
NPI:1942873773
Name:CLOUGH, MACKENZIE ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ANNE
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 E BETHANY DR STE 355
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2806
Mailing Address - Country:US
Mailing Address - Phone:720-413-0980
Mailing Address - Fax:877-599-0808
Practice Address - Street 1:10730 E BETHANY DR STE 355
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2806
Practice Address - Country:US
Practice Address - Phone:720-413-0980
Practice Address - Fax:877-599-0808
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019722101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional