Provider Demographics
NPI:1497505598
Name:SEGURA-MOORE, PEDRO JUAN CARLOS (ALMFT)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:JUAN CARLOS
Last Name:SEGURA-MOORE
Suffix:
Gender:M
Credentials:ALMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5554 S HYDE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1909
Mailing Address - Country:US
Mailing Address - Phone:703-458-3307
Mailing Address - Fax:
Practice Address - Street 1:5554 S HYDE PARK BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1909
Practice Address - Country:US
Practice Address - Phone:773-345-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.001078106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist