Cottontree Center – Multi-Specialty Clinic/Center

Key facts

NPI: 1104803675
Entity type: Organization (NPI type 2)
Primary specialty: Multi-Specialty Clinic/Center 261QM1300X
License: 200110082 (NM)
Legal business name: COTTONTREE CENTER
Practice address: 190 Central Park SQ
Suite 105
Los Alamos, NM 87544-4001
Phone: (505) 662-1419
Fax: (505) 672-1739
NPI assigned: Dec 27, 2005
Organization subpart: No

Authorized official

Name: Donna Marie Giaquinto, LPCC NPI 1154319788
Title: Director
Phone: (505) 662-1419

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Donna Marie Giaquinto, LPCC School Psychologist · Los Alamos, NM · NPI 1154319788

NPD (past) Authorized official

National Provider Directory

Locations

190 Central Park Sq
Ste 105
Los Alamos, NM 87544
Phone (505) 662-1419

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Multi-Specialty Clinic/Center	261QM1300X	200110082	NM	Yes

Addresses

Primary practice location

190 Central Park SQ
Suite 105
Los Alamos, NM 87544-4001

Mailing address

190 Central Park SQ
Suite 105
Los Alamos, NM 87544-4001
Phone (505) 662-1419

Other identifiers

Identifier	Type	State	Issuer
000B9545	Medicaid	NM

Other names

Cottonwood Therapy Associate Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 25, 2009.

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237939200000",
    "number": "1104803675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 CENTRAL PARK SQ",
            "address_2": "SUITE 105",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "875444001",
            "telephone_number": "505-662-1419",
            "fax_number": "505-672-1739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 CENTRAL PARK SQ",
            "address_2": "SUITE 105",
            "city": "LOS ALAMOS",
            "state": "NM",
            "postal_code": "875444001",
            "telephone_number": "505-662-1419",
            "fax_number": "505-672-1739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COTTONTREE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-27",
        "last_updated": "2009-03-25",
        "status": "A",
        "authorized_official_last_name": "GIAQUINTO",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "505-662-1419",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NM",
            "license": "200110082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000B9545",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cottonwood Therapy Associate",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Alamos, NM

All providers in Los Alamos, NM · Multi-Specialty Clinic/Center in New Mexico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2009. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.