Provider Demographics
NPI:1508344888
Name:SEGURA, TALIA
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:SEGURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 SAN PEDRO DR NE TRLR 112
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4601
Mailing Address - Country:US
Mailing Address - Phone:505-236-3350
Mailing Address - Fax:
Practice Address - Street 1:11005 SPAIN RD NE STE 15
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1871
Practice Address - Country:US
Practice Address - Phone:505-322-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTL0198091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health