Healthcare Provider Details

I. General information

NPI: 1538475199
Provider Name (Legal Business Name): RICHARD J GALE PSYD, HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6437 RUCKER RD STE C
INDIANAPOLIS IN
46220-4868
US

IV. Provider business mailing address

5124 REFORMATORY RD
PENDLETON IN
46064-8767
US

V. Phone/Fax

Practice location:
  • Phone: 317-426-6318
  • Fax: 317-516-0924
Mailing address:
  • Phone: 765-778-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20042697A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: