Healthcare Provider Details

I. General information

NPI: 1831930304
Provider Name (Legal Business Name): GALE PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6437 RUCKER RD STE C
INDIANAPOLIS IN
46220-4868
US

IV. Provider business mailing address

6437 RUCKER RD STE C
INDIANAPOLIS IN
46220-4868
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACY M. GALE
Title or Position: OWNER
Credential: PSY.D., HSPP
Phone: 317-426-6318