Provider Demographics
NPI:1265783542
Name:FUTRELL, NATHAN GILES (MA, LPC)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:GILES
Last Name:FUTRELL
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 THOMPSON TER
Mailing Address - Street 2:STE 103
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5850
Mailing Address - Country:US
Mailing Address - Phone:817-281-6822
Mailing Address - Fax:817-503-1996
Practice Address - Street 1:5009 THOMPSON TER
Practice Address - Street 2:STE 103
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5850
Practice Address - Country:US
Practice Address - Phone:817-281-6822
Practice Address - Fax:817-503-1996
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66067101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional