Healthcare Provider Details

I. General information

NPI: 1700559101
Provider Name (Legal Business Name): RIVER GERARD SEGAR SWC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 S SANTA FE DR
LITTLETON CO
80120-2910
US

IV. Provider business mailing address

116 INVERNESS DR E STE 105
ENGLEWOOD CO
80112-5125
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-8858
  • Fax:
Mailing address:
  • Phone: 303-730-8858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSWC0000002801
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: