Provider Demographics
NPI:1699793315
Name:LELEK, STANLEY P (PSY D)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:P
Last Name:LELEK
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 CHICAGO ST STE F
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5863
Mailing Address - Country:US
Mailing Address - Phone:219-464-4195
Mailing Address - Fax:219-464-4195
Practice Address - Street 1:2503 CHICAGO ST STE F
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5863
Practice Address - Country:US
Practice Address - Phone:219-464-4195
Practice Address - Fax:219-464-4195
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCO14101YA0400X
IN20040005103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100209720AMedicaid
000000213402OtherBCBS
IN100209720AMedicaid