Become A Member

Your Name *

First Name

Last Name

Agency Location *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Representative of Agency *

First Name

Last Name

Representative's Phone Number *

(###)

###

####

Services Provided *

Hospital

Inpatient Detox

Outpatient Detox

Residential Substance Use

Inpatient Mental Health

Residential Mental Health

Sober Living/Transitional Living

Partial Hospitalization Substance Use

Partial Hospitalization Mental Health

Intensive Outpatient Substance Use

Intensive Outpatient Mental Health

Adolescent Treatment

MAT

Outpatient Substance Use

Outpatient Mental Health

Private Practice Medical

Private Practice Therapy

Peer Support

Advocate

Helpline

Recovery Tools

Drop-in Center

Other

Insurances Accepted *

Private Pay

Commercial

Medicaid

Medicare

IHS

Tri-care

Payment Not Required

Other

Admissions/Main Contact

First Name

Last Name

Admissions Phone

(###)

###

####

Permission to publish provided information in NM Leaders in Recovery Resource Guide? *

Yes, I give permission to publish the provided information.

No, I do not give my permission for publication.