Organization
FORT COLLINS COMMUNITY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIA MAYA CHATTERJEE (MARRIAGE AND FAMILY THERAPIST)
(415) 728-2191
Entity
Organization
Contact information
Practice address
1507 RIVERSIDE AVE, FORT COLLINS, CO 80524-4382
(415) 728-2191
Mailing address
309 S LOOMIS AVE, FORT COLLINS, CO 80521-2542
(415) 728-2191
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
—
—
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750110177
NPI
CO
Enumeration date
08/01/2024
Last updated
08/01/2024
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