Organization
WIDE OPEN COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARNELL E MCCLEOD LCSW (OWNER)
(915) 777-8118
Entity
Organization
Contact information
Practice address
1685 S DON ROSER DR STE D, LAS CRUCES, NM 88011-4586
(575) 805-6288
Mailing address
PO BOX 1992, MESILLA PARK, NM 88047-1992
(575) 805-6288
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851979256
NPI
—
01
—
X-11858
PROVISIONAL CLINICAL SOCIAL WORKER
NM
Enumeration date
04/02/2021
Last updated
04/23/2021
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