Provider Demographics
NPI:1043532229
Name:FUTRELL, MELISSA FAY
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:FAY
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 1:103 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-9102
Mailing Address - Country:US
Mailing Address - Phone:870-213-5025
Mailing Address - Fax:
Practice Address - Street 1:103 ALLEN RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-9102
Practice Address - Country:US
Practice Address - Phone:870-213-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR95-21E101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor