Healthcare Provider Details

I. General information

NPI: 1720396229
Provider Name (Legal Business Name): ANNA R FUTRELL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 7TH STREET
CHAMA NM
87520-0874
US

IV. Provider business mailing address

PO BOX 874
CHAMA NM
87520-0874
US

V. Phone/Fax

Practice location:
  • Phone: 575-756-2438
  • Fax: 575-756-2438
Mailing address:
  • Phone: 575-756-2438
  • Fax: 575-756-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0129461
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number31640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: