Provider Demographics
NPI:1437922242
Name:FUTRELL, MAKENA STONE (LPCA)
Entity Type:Individual
Prefix:MISS
First Name:MAKENA
Middle Name:STONE
Last Name:FUTRELL
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 NANCY CIR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-4109
Mailing Address - Country:US
Mailing Address - Phone:903-241-6616
Mailing Address - Fax:
Practice Address - Street 1:2000 E COTTON ST STE 700
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602-1514
Practice Address - Country:US
Practice Address - Phone:903-500-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89086101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional