Provider Demographics
NPI:1003137456
Name:TWIN DREAMS LLC
Entity Type:Organization
Organization Name:TWIN DREAMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNEER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGERY
Authorized Official - Middle Name:H
Authorized Official - Last Name:RUNYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:970-946-0992
Mailing Address - Street 1:351 CHERRY GULCH RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6469
Mailing Address - Country:US
Mailing Address - Phone:970-946-0992
Mailing Address - Fax:
Practice Address - Street 1:351 CHERRY GULCH RD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6469
Practice Address - Country:US
Practice Address - Phone:970-946-0992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW88441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11827750OtherCAQH
FL001188500Medicaid
11827750OtherCAQH