Provider Demographics
NPI:1407155104
Name:DOUP, DAWN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:A
Last Name:DOUP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 E TIPTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-3561
Mailing Address - Country:US
Mailing Address - Phone:812-523-0386
Mailing Address - Fax:812-523-8416
Practice Address - Street 1:1725 E TIPTON ST STE 200
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3561
Practice Address - Country:US
Practice Address - Phone:812-523-0386
Practice Address - Fax:812-523-8416
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042503A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200822750BMedicaid