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General NPI Number Information
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NPI Number | 1134636590
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Entity Type | Organization
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Legal Business Name | VOYAGE LLC
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 222 US HIGHWAY 41 STE 207
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City | SCHERERVILLE
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State | IN
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Zip | 46375-1275
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Country | US
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Telephone | 219-712-2696
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Fax |
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Provider Business Mailing Address
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Address Line | 222 US HIGHWAY 41 STE 207
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City | SCHERERVILLE
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State | IN
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Zip | 46375-1275
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Country | US
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Telephone | 219-712-2696
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AUSTIN JEROME MALONE
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Credential | M.A. LMHC
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Telephone | 219-629-9053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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