Provider Demographics
NPI:1609508134
Name:FLOYD, JALEY (LCAC)
Entity type:Individual
Prefix:
First Name:JALEY
Middle Name:
Last Name:FLOYD
Suffix:
Gender:
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-1241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:815 SHORT ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-1241
Practice Address - Country:US
Practice Address - Phone:812-972-1857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2025-04-25
Deactivation Date:2022-10-06
Deactivation Code:
Reactivation Date:2025-04-25
Provider Licenses
StateLicense IDTaxonomies
IN87001657A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)