Healthcare Provider Details

I. General information

NPI: 1619761137
Provider Name (Legal Business Name): SOUTHWEST COLORADO MENTAL HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27B TALISMAN DR UNIT 3
PAGOSA SPRINGS CO
81147-7914
US

IV. Provider business mailing address

PO BOX 1328
DURANGO CO
81302-1328
US

V. Phone/Fax

Practice location:
  • Phone: 970-372-0456
  • Fax:
Mailing address:
  • Phone: 970-335-2342
  • Fax: 970-335-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JANET ACCOMANDO PETTY
Title or Position: DIRECTOR
Credential:
Phone: 970-497-6384