Healthcare Provider Details

I. General information

NPI: 1760799886
Provider Name (Legal Business Name): GUSTAVO SEGURA HERNANDEZ PHD, MP, ABPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 STUBBS AVE
MONROE LA
71201-5628
US

IV. Provider business mailing address

1340 POYDRAS ST STE 1770
NEW ORLEANS LA
70112-5204
US

V. Phone/Fax

Practice location:
  • Phone: 727-834-0034
  • Fax: 318-323-8757
Mailing address:
  • Phone: 727-834-0034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY9350
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY9350
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number334132
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: