Provider Demographics
NPI:1407819071
Name:SEGURA, KRISTON A (PSY D)
Entity Type:Individual
Prefix:DR
First Name:KRISTON
Middle Name:A
Last Name:SEGURA
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 E FLAMINGO RD STE 321
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5190
Mailing Address - Country:US
Mailing Address - Phone:702-308-5114
Mailing Address - Fax:702-829-5403
Practice Address - Street 1:2110 E FLAMINGO RD STE 321
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5190
Practice Address - Country:US
Practice Address - Phone:702-308-5114
Practice Address - Fax:702-410-8401
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0416103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503120Medicaid
NVV103462Medicare PIN