Healthcare Provider Details

I. General information

NPI: 1699793315
Provider Name (Legal Business Name): STANLEY P LELEK PSY D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 CHICAGO ST STE F
VALPARAISO IN
46383-5863
US

IV. Provider business mailing address

2503 CHICAGO ST STE F
VALPARAISO IN
46383-5863
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-4195
  • Fax: 219-464-4195
Mailing address:
  • Phone: 219-464-4195
  • Fax: 219-464-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO14
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20040005
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: