# FORT COLLINS COMMUNITY CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518797943
- **Authorized official:** JULIA MAYA CHATTERJEE (MARRIAGE AND FAMILY THERAPIST)
- **Authorized official phone:** (415) 728-2191

## Contact information

- **Practice address:** 1507 RIVERSIDE AVE, FORT COLLINS, CO 80524-4382
- **Practice address phone:** (415) 728-2191
- **Mailing address:** 309 S LOOMIS AVE, FORT COLLINS, CO 80521-2542
- **Mailing address phone:** (415) 728-2191

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC1900X | Counseling Psychologist | — | NULL | — |
| 103TC1900X | Counseling Psychologist | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 08/01/2024
- **Last updated:** 08/01/2024