1588138325 NPI number — MCCLAIN COUNSELING SERVICES, LLC

Table of content: (NPI 1407887532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588138325 NPI number — MCCLAIN COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCLAIN COUNSELING SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588138325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 692
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGH ROLLS MOUNTAIN PARK
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88325-0692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-603-0008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 DOUBLE EACLE # 692
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGH ROLLS MOUNTAIN PARK
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88325-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-319-4145
Provider Business Practice Location Address Fax Number:
417-290-2209
Provider Enumeration Date:
01/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
PENROD
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
MCCLAIN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
505-603-0008

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1669497335 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 830157388 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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