Provider Demographics
NPI:1285395673
Name:SEGAR, AGNES VIRGINIA (LMFT)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:VIRGINIA
Last Name:SEGAR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:SEGAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:8912 HUBBARD ST.
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232
Mailing Address - Country:US
Mailing Address - Phone:949-861-1734
Mailing Address - Fax:
Practice Address - Street 1:8912 HUBBARD ST.
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232
Practice Address - Country:US
Practice Address - Phone:949-861-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102658106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty