MEDICARE: PARIS FUTRELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	12329A	NC

General Provider Information

NPI Number	:	1013400621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARIS FUTRELL

Provider Business Mailing Address
First Line	:	5 OAK BRANCH DR STE G
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-2157
Country	:	US
Telephone Number	:	252-319-2114
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 OAK BRANCH DR STE G
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-2157
Country	:	US
Telephone Number	:	252-319-2114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2018
Last Update Date	:	09/21/2021

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