Healthcare Provider Details

I. General information

NPI: 1548256795
Provider Name (Legal Business Name): KEVIN PATRICK DUGAN PHD, HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10293 N MERIDIAN ST SUITE 375
INDIANAPOLIS IN
46290-1123
US

IV. Provider business mailing address

10293 N MERIDIAN ST SUITE 375
INDIANAPOLIS IN
46290-1123
US

V. Phone/Fax

Practice location:
  • Phone: 317-581-2288
  • Fax:
Mailing address:
  • Phone: 317-581-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20041836A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: