Provider Demographics
NPI:1699084103
Name:SEGAL, RENEE (LMFT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:SEGAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13911 RIDGEDALE DR STE 335
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1775
Mailing Address - Country:US
Mailing Address - Phone:612-875-6416
Mailing Address - Fax:952-546-3000
Practice Address - Street 1:9800 SHELARD PKWY # 115
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55441-6411
Practice Address - Country:US
Practice Address - Phone:612-875-6416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist