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General NPI Number Information
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NPI Number | 1508344888
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Entity Type | Individual
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Provider Name | TALIA SEGURA
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Gender | Female
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 11005 SPAIN RD NE STE 15
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-1871
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Country | US
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Telephone | 505-322-6837
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Fax |
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Provider Business Mailing Address
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Address Line | 7401 SAN PEDRO DR NE TRLR 112
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4601
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Country | US
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Telephone | 505-236-3350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CTL0198091
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License Number State | NM
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