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General NPI Number Information
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NPI Number | 1760799886
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Entity Type | Individual
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Provider Name | GUSTAVO SEGURA HERNANDEZ PHD, MP, ABPP
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Gender | Male
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 1502 STUBBS AVE
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City | MONROE
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State | LA
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Zip | 71201-5628
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Country | US
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Telephone | 727-834-0034
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Fax | 318-323-8757
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Provider Business Mailing Address
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Address Line | 1340 POYDRAS ST STE 1770
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City | NEW ORLEANS
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State | LA
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Zip | 70112-5204
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Country | US
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Telephone | 727-834-0034
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PY9350
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY9350
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 334132
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License Number State | LA
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