Provider Demographics
NPI:1386268639
Name:SEGOVIA, JAVIER (LCSW)
Entity type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:
Last Name:SEGOVIA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 W KIKA DE LA GARZA ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3734
Mailing Address - Country:US
Mailing Address - Phone:956-445-4383
Mailing Address - Fax:
Practice Address - Street 1:1209 W KIKA DE LA GARZA ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3734
Practice Address - Country:US
Practice Address - Phone:956-445-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health