Provider Demographics
NPI:1518636711
Name:DUGYALA, MADHURI (LMHCA)
Entity Type:Individual
Prefix:
First Name:MADHURI
Middle Name:
Last Name:DUGYALA
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 GRAVES LIGHT DR APT N
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-8769
Mailing Address - Country:US
Mailing Address - Phone:510-589-6464
Mailing Address - Fax:
Practice Address - Street 1:600 N JORDAN AVE FL 4
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405-3190
Practice Address - Country:US
Practice Address - Phone:812-855-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001157A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN88001157AOtherINDIANA PROFESSIONAL LICENSING AGENCY BEHAVIORAL HEALTH AND HUMAN SERVICES BOARD