Provider Demographics
NPI:1720396229
Name:FUTRELL, ANNA R (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:R
Last Name:FUTRELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:CHAMA
Mailing Address - State:NM
Mailing Address - Zip Code:87520-0874
Mailing Address - Country:US
Mailing Address - Phone:575-756-2438
Mailing Address - Fax:575-756-2438
Practice Address - Street 1:551 7TH STREET
Practice Address - Street 2:
Practice Address - City:CHAMA
Practice Address - State:NM
Practice Address - Zip Code:87520-0874
Practice Address - Country:US
Practice Address - Phone:575-756-2438
Practice Address - Fax:575-756-2438
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0129461106H00000X
CA31640106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist