Healthcare Provider Details

I. General information

NPI: 1548354251
Provider Name (Legal Business Name): CORTEZ ADDICTIONS RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 N. ASH STREET
CORTEZ CO
81321
US

IV. Provider business mailing address

35 N. ASH STREET
CORTEZ CO
81321
US

V. Phone/Fax

Practice location:
  • Phone: 970-565-4109
  • Fax: 970-565-8804
Mailing address:
  • Phone: 970-565-4109
  • Fax: 970-565-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1277-00
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1277-00
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number127700
License Number StateCO

VIII. Authorized Official

Name: DR. ANN L. WETTON
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 970-565-4109