Provider Demographics
NPI:1386165843
Name:SEGAL, ALIK (MFTI)
Entity type:Individual
Prefix:
First Name:ALIK
Middle Name:
Last Name:SEGAL
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N SWALL DR APT 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6807
Mailing Address - Country:US
Mailing Address - Phone:310-751-0616
Mailing Address - Fax:
Practice Address - Street 1:128 N SWALL DR APT 107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6807
Practice Address - Country:US
Practice Address - Phone:310-751-0616
Practice Address - Fax:310-751-0616
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist