Healthcare Provider Details

I. General information

NPI: 1790695849
Provider Name (Legal Business Name): COTTONWOOD CLINICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 N SCHWARTZ AVE
FARMINGTON NM
87401-5547
US

IV. Provider business mailing address

653 W ARRINGTON ST
FARMINGTON NM
87401-8513
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4584
  • Fax:
Mailing address:
  • Phone: 505-564-3733
  • Fax: 505-564-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEFANI GURLEY
Title or Position: COO
Credential:
Phone: 505-564-3733