{
"Npi": {
"NPI": "1790695849",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "COTTONWOOD CLINICAL SERVICES, INC.",
"ParentOrgTIN": null,
"OrgName": "COTTONWOOD CLINICAL SERVICES, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "653 W ARRINGTON ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FARMINGTON",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87401-8513",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-564-3733",
"MailingAddressFaxNumber": "505-564-3788",
"FirstLinePracticeLocationAddress": "228 N SCHWARTZ AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FARMINGTON",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "87401-5547",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-327-4584",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/10/2026",
"LastUpdateDate": "09/10/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GURLEY",
"AuthorizedOfficialFirstName": "STEFANI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "COO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "505-564-3733",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "251S00000X",
"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}