Healthcare Provider Details

I. General information

NPI: 1831051663
Provider Name (Legal Business Name): LETICIA GALEY BS/PASTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6474 CENTRAL AVE.
POCTASE IN
46368
US

IV. Provider business mailing address

6474 CENTRAL AVE.
POCTASE IN
46368
US

V. Phone/Fax

Practice location:
  • Phone: 219-764-8229
  • Fax:
Mailing address:
  • Phone: 219-764-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: