Provider Demographics
NPI:1093422958
Name:PENROD, KATILYN JEANETTE (LMFT)
Entity type:Individual
Prefix:
First Name:KATILYN
Middle Name:JEANETTE
Last Name:PENROD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 400 BOX 4304
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96273-0044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233, DU-RI, PAENGSEONG-EUP
Practice Address - Street 2:CENTERIUM #C401
Practice Address - City:PYEONGTEAK-SI
Practice Address - State:GYEONGGI-DO
Practice Address - Zip Code:17975
Practice Address - Country:KR
Practice Address - Phone:103-280-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01181106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist