Provider Demographics
NPI:1013400621
Name:FUTRELL, PARIS
Entity Type:Individual
Prefix:
First Name:PARIS
Middle Name:
Last Name:FUTRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 OAK BRANCH DR STE G
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2157
Mailing Address - Country:US
Mailing Address - Phone:252-319-2114
Mailing Address - Fax:
Practice Address - Street 1:5 OAK BRANCH DR STE G
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2157
Practice Address - Country:US
Practice Address - Phone:252-319-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12329A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist