Provider Demographics
NPI:1588138325
Name:MCCLAIN COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:MCCLAIN COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:MCCLAIN
Authorized Official - Last Name:PENROD
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-603-0008
Mailing Address - Street 1:PO BOX 692
Mailing Address - Street 2:
Mailing Address - City:HIGH ROLLS MOUNTAIN PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88325-0692
Mailing Address - Country:US
Mailing Address - Phone:505-603-0008
Mailing Address - Fax:
Practice Address - Street 1:11 DOUBLE EACLE # 692
Practice Address - Street 2:
Practice Address - City:HIGH ROLLS MOUNTAIN PARK
Practice Address - State:NM
Practice Address - Zip Code:88325-9000
Practice Address - Country:US
Practice Address - Phone:417-319-4145
Practice Address - Fax:417-290-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1669497335Medicaid
MO830157388Medicaid