Provider Demographics
NPI:1588948053
Name:SEGAL, KATHY S
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:S
Last Name:SEGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2118
Mailing Address - Country:US
Mailing Address - Phone:907-339-4403
Mailing Address - Fax:907-272-1466
Practice Address - Street 1:750 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2118
Practice Address - Country:US
Practice Address - Phone:907-339-4403
Practice Address - Fax:907-272-1466
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK101YMO800XMedicaid