Provider Demographics
NPI:1710367131
Name:DOUP PSYCHOLOGY GROUP LLC
Entity type:Organization
Organization Name:DOUP PSYCHOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOUP
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:812-657-4784
Mailing Address - Street 1:450 JACKSON ST UNIT 1495
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47202-2860
Mailing Address - Country:US
Mailing Address - Phone:812-657-4784
Mailing Address - Fax:812-379-8068
Practice Address - Street 1:424 WASHINGTON ST STE 7
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6790
Practice Address - Country:US
Practice Address - Phone:812-657-4784
Practice Address - Fax:812-379-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042503A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201014370Medicaid