MEDICARE: JOAN C SEGO LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC.0023145	CO

General Provider Information

NPI Number	:	1053158717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN C SEGO LPC

Provider Business Mailing Address
First Line	:	435 EDWARDS ACCESS RD
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632-5633
Country	:	US
Telephone Number	:	970-855-7378
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 EDWARDS ACCESS RD
Second Line	:
City	:	EDWARDS
State	:	CO
Zip	:	81632-5633
Country	:	US
Telephone Number	:	970-855-7378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	12/02/2025

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