Provider Demographics
NPI:1114312048
Name:SEGAL PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:SEGAL PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-875-6416
Mailing Address - Street 1:9800 SHELARD PKWY # 115
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6411
Mailing Address - Country:US
Mailing Address - Phone:612-875-6416
Mailing Address - Fax:
Practice Address - Street 1:9800 SHELARD PKWY # 115
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6411
Practice Address - Country:US
Practice Address - Phone:612-875-6416
Practice Address - Fax:952-546-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-28
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2108261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1776903Medicaid