Provider Demographics
NPI:1881114866
Name:MADRONE CENTER FOR COUNSELING, PLLC
Entity type:Organization
Organization Name:MADRONE CENTER FOR COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC
Authorized Official - Phone:469-556-1081
Mailing Address - Street 1:2115 STEPHENS PL STE 410E
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2170
Mailing Address - Country:US
Mailing Address - Phone:972-379-8303
Mailing Address - Fax:
Practice Address - Street 1:2115 STEPHENS PL STE 410E
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2170
Practice Address - Country:US
Practice Address - Phone:972-379-8303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12817261QM0850X, 261QM0855X
TX69730261QM0855X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health