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General NPI Number Information
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NPI Number | 1205322666
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Entity Type | Organization
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Legal Business Name | THE FAMILY CENTER/LA FAMILIA
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Dates
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Enumeration Date | 07/09/2018
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Last Update Date | 12/12/2018
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Provider Practice Location Address
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Address Line | 309 HICKORY ST # 5
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City | FORT COLLINS
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State | CO
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Zip | 80524-1106
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Country | US
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Telephone | 970-221-1615
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Fax | 970-416-7448
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Provider Business Mailing Address
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Address Line | 309 HICKORY ST # 5
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City | FORT COLLINS
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State | CO
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Zip | 80524-1106
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Country | US
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Telephone | 970-221-1615
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Fax | 970-416-7448
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DEIRDRE SULLIVAN
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Credential |
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Telephone | 970-221-1615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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