Provider Demographics
NPI:1467701037
Name:PEACEFUL PATH COUNSELING LLC
Entity Type:Organization
Organization Name:PEACEFUL PATH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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 LISW CADAC
Authorized Official - Phone:970-946-0992
Mailing Address - Street 1:1199 MAIN AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4158
Mailing Address - Country:US
Mailing Address - Phone:970-946-0992
Mailing Address - Fax:239-558-5775
Practice Address - Street 1:1199 MAIN AVE STE 214
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4158
Practice Address - Country:US
Practice Address - Phone:970-946-0992
Practice Address - Fax:239-558-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1042101YA0400X
CO6697101YA0400X
NMI055691041C0700X
CO96300221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64856232Medicaid
NM31882021Medicaid