Provider Demographics
NPI:1710697420
Name:DEMOUGIN, LAURA KAY
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KAY
Last Name:DEMOUGIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 N MADISON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-2301
Mailing Address - Country:US
Mailing Address - Phone:812-379-8696
Mailing Address - Fax:
Practice Address - Street 1:390 N MADISON AVE STE 200
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-2301
Practice Address - Country:US
Practice Address - Phone:812-379-8696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99114231A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health