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NPI Code Detail

MEDICARE: COTTONWOOD CLINICAL SERVICES, INC.

MEDICARE: COTTONWOOD CLINICAL SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor0090031NM
2101YM0800XMental Health CounselorI-06858NM
3251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1790019420
Entity Type Code : Organization
Provider Name (Legal Business Name) : COTTONWOOD CLINICAL SERVICES, INC.
Provider Business Mailing Address
First Line : 653 W ARRINGTON ST
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-8513
Country : US
Telephone Number : 505-564-3733
Fax Number : 505-564-3788
Provider Business Practice Location Address
First Line : 653 W ARRINGTON ST
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-8513
Country : US
Telephone Number : 505-564-3733
Fax Number : 505-564-3788
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : KIM D DUTREMAINE
Credential : LISW
Telephone Number : 505-564-3733
Provider Enumeration Date : 09/29/2009
Last Update Date : 07/10/2025

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Directions to “COTTONWOOD CLINICAL SERVICES, INC. ” Practice Location

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