Provider Demographics
NPI:1699111823
Name:SEGURA, ANNETTE (LPC-S)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:SEGURA
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W RANDOL MILL RD
Mailing Address - Street 2:SUITE 236
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4611
Mailing Address - Country:US
Mailing Address - Phone:682-207-8313
Mailing Address - Fax:
Practice Address - Street 1:110 W RANDOL MILL RD
Practice Address - Street 2:SUITE 236
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4611
Practice Address - Country:US
Practice Address - Phone:682-207-8313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX328444001Medicaid