Provider Demographics
NPI:1871936377
Name:SEGURA-HERRERA, THERESA (PHD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:SEGURA-HERRERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 N CLARENDON AVE
Mailing Address - Street 2:SUITE 2110
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2698
Mailing Address - Country:US
Mailing Address - Phone:312-909-1007
Mailing Address - Fax:773-327-4542
Practice Address - Street 1:6250 W NORTH AVE
Practice Address - Street 2:1ST FL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-3861
Practice Address - Country:US
Practice Address - Phone:312-909-1007
Practice Address - Fax:773-327-4542
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008568103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical