Individual
MADHURI DUGYALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHCA
Contact information
Practice address
600 N JORDAN AVE FL 4, BLOOMINGTON, IN 47405-3190
(812) 855-5711
Mailing address
2309 GRAVES LIGHT DR APT N, INDIANAPOLIS, IN 46217-8769
(510) 589-6464
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
88001157A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88001157A
INDIANA PROFESSIONAL LICENSING AGENCY BEHAVIORAL HEALTH AND HUMAN SERVICES BOARD
IN
Enumeration date
09/10/2021
Last updated
09/10/2021
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