Healthcare Provider Details

I. General information

NPI: 1255345591
Provider Name (Legal Business Name): MARY TWINEM PSY.D., M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 INDIANA AVE
PUEBLO CO
81004-3747
US

IV. Provider business mailing address

924 INDIANA AVE
PUEBLO CO
81004-3747
US

V. Phone/Fax

Practice location:
  • Phone: 719-564-9039
  • Fax: 719-561-8752
Mailing address:
  • Phone: 719-564-9039
  • Fax: 719-561-8752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number723
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number377
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: