Provider Demographics
NPI:1073065116
Name:SEGURA, LENNYN
Entity Type:Individual
Prefix:
First Name:LENNYN
Middle Name:
Last Name:SEGURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10075 LEVON AVE
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0443
Mailing Address - Country:US
Mailing Address - Phone:530-582-7814
Mailing Address - Fax:
Practice Address - Street 1:10075 LEVON AVE
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0443
Practice Address - Country:US
Practice Address - Phone:530-847-8142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health