Healthcare Provider Details

I. General information

NPI: 1205322666
Provider Name (Legal Business Name): THE FAMILY CENTER/LA FAMILIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 HICKORY ST # 5
FORT COLLINS CO
80524-1106
US

IV. Provider business mailing address

309 HICKORY ST # 5
FORT COLLINS CO
80524-1106
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-1615
  • Fax: 970-416-7448
Mailing address:
  • Phone: 970-221-1615
  • Fax: 970-416-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DEIRDRE SULLIVAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 970-221-1615