Provider Demographics
NPI:1326863366
Name:SEGURA, SAIDALID (SW)
Entity type:Individual
Prefix:
First Name:SAIDALID
Middle Name:
Last Name:SEGURA
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:SEGURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SAIDALID SEGURA
Mailing Address - Street 1:630 BROCTON ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3057
Mailing Address - Country:US
Mailing Address - Phone:361-935-8750
Mailing Address - Fax:
Practice Address - Street 1:120 DAVID WADE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77905-4404
Practice Address - Country:US
Practice Address - Phone:361-484-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112980101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor