MEDICARE: ALYSSA JOY PENROD LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0717002476	VA

General Provider Information

NPI Number	:	1457235525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA JOY PENROD LMFT

Provider Business Mailing Address
First Line	:	1075 LIGHT BLVD
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-5094
Country	:	US
Telephone Number	:	888-808-6050
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 LIGHT BLVD
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-5094
Country	:	US
Telephone Number	:	888-808-6050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2025
Last Update Date	:	08/24/2025

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Directions to “ ALYSSA JOY PENROD LMFT” Practice Location

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