Healthcare Provider Details

I. General information

NPI: 1255012506
Provider Name (Legal Business Name): PAIGE MADDEX & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LINCOLNWAY STE 2
VALPARAISO IN
46383-6722
US

IV. Provider business mailing address

1481 LOBWEDGE LN
CHESTERTON IN
46304-9171
US

V. Phone/Fax

Practice location:
  • Phone: 219-252-4298
  • Fax:
Mailing address:
  • Phone: 219-252-4298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL ALAN WEAVER
Title or Position: CEO
Credential:
Phone: 219-241-5663