MEDICARE: MISS SAMANTHA ASHLEY SEGALL MA

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	106596	CA
2	106H00000X	Marriage & Family Therapist	106596	CA
3	101YP2500X	Professional Counselor	0016497	CO

General Provider Information

NPI Number	:	1073028759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SAMANTHA ASHLEY SEGALL MA

Provider Business Mailing Address
First Line	:	1880 LITTLE RAVEN ST APT 144
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-6498
Country	:	US
Telephone Number	:	310-905-2905
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 LITTLE RAVEN ST APT 144
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-6498
Country	:	US
Telephone Number	:	310-905-2905
Fax Number	:

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

Provider Enumeration Date	:	12/04/2017
Last Update Date	:	11/12/2021

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