Provider Demographics
NPI:1487783239
Name:SEGUIN, GARY THOMAS (LPC, LCDC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:THOMAS
Last Name:SEGUIN
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4444
Mailing Address - Country:US
Mailing Address - Phone:214-682-7938
Mailing Address - Fax:
Practice Address - Street 1:203 N JACKSON AVE
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4444
Practice Address - Country:US
Practice Address - Phone:214-682-7938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10321101YA0400X
TX62101101YP2500X
TXLPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health