Healthcare Provider Details

I. General information

NPI: 1669497335
Provider Name (Legal Business Name): ROBIN MCCLAIN PENROD M.A., L..P.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 CUBA AVE STE 5
ALAMOGORDO NM
88310-5646
US

IV. Provider business mailing address

PO BOX 692
HIGH ROLLS MOUNTAIN PARK NM
88325-0692
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-0008
  • Fax:
Mailing address:
  • Phone: 56-030-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0084021
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: