Provider Demographics
NPI:1134636590
Name:VOYAGE LLC
Entity Type:Organization
Organization Name:VOYAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMHC
Authorized Official - Phone:219-629-9053
Mailing Address - Street 1:222 US HIGHWAY 41 STE 207
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1275
Mailing Address - Country:US
Mailing Address - Phone:219-712-2696
Mailing Address - Fax:
Practice Address - Street 1:222 US HIGHWAY 41 STE 207
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1275
Practice Address - Country:US
Practice Address - Phone:219-712-2696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty