Healthcare Provider Details

I. General information

NPI: 1598060964
Provider Name (Legal Business Name): LINDA M PENROD MS, LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 NILLES RD SUITE 5
FAIRFIELD OH
45014-7206
US

IV. Provider business mailing address

1251 NILLES RD SUITE 5
FAIRFIELD OH
45014-7206
US

V. Phone/Fax

Practice location:
  • Phone: 513-939-0300
  • Fax: 513-939-0310
Mailing address:
  • Phone: 513-939-0300
  • Fax: 513-939-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0700453-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: