Provider Demographics
NPI:1508254194
Name:SEGAL, MARGERY ELLEN (LPC)
Entity Type:Individual
Prefix:
First Name:MARGERY
Middle Name:ELLEN
Last Name:SEGAL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 RIO GRANDE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1123
Mailing Address - Country:US
Mailing Address - Phone:802-324-1731
Mailing Address - Fax:
Practice Address - Street 1:1709 RIO GRANDE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1123
Practice Address - Country:US
Practice Address - Phone:802-324-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health