Provider Demographics
NPI:1932540259
Name:DUGAN PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:DUGAN PSYCHOTHERAPY, PLLC
Other - Org Name:DUGAN PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:RUSH
Authorized Official - Last Name:DUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-567-6358
Mailing Address - Street 1:6 JUNKIN PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-1822
Mailing Address - Country:US
Mailing Address - Phone:512-567-6358
Mailing Address - Fax:737-263-1106
Practice Address - Street 1:6 JUNKIN PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-1822
Practice Address - Country:US
Practice Address - Phone:512-567-6358
Practice Address - Fax:737-263-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64553101YP2500X
TX406711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty