Individual
JEREMIAH L. PENROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SMFT
Contact information
Practice address
560 W MOUNT VERNON ST, NIXA, MO 65714-9681
(417) 413-1593
Mailing address
2108 W VISTA ST, SPRINGFIELD, MO 65807-5918
(417) 597-4309
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
10/01/2013
Last updated
10/01/2013
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