Organization
COTTONWOOD THERAPEUTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN R. WILLOUGHBY LCSW (LCSW, OWNER)
(505) 459-1260
Entity
Organization
Contact information
Practice address
2900 LOUISIANA BLVD NE STE H, ALBUQUERQUE, NM 87110-3565
(505) 459-1260
Mailing address
1800 GEORGIA ST NE, ALBUQUERQUE, NM 87110-5903
(505) 459-1260
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11401346
—
NM
Enumeration date
03/30/2021
Last updated
11/29/2024
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