Healthcare Provider Details

I. General information

NPI: 1871401422
Provider Name (Legal Business Name): ADDISON FUTRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

858 GALLOWAY RD # A
MAYFIELD KY
42066-4826
US

IV. Provider business mailing address

210 PASSAGE DR # A
MURRAY KY
42071-5402
US

V. Phone/Fax

Practice location:
  • Phone: 270-819-6036
  • Fax:
Mailing address:
  • Phone: 502-938-1595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number274693
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: