Provider Demographics
NPI:1598212326
Name:INFINITE JOURNEY, LLC
Entity Type:Organization
Organization Name:INFINITE JOURNEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMELLA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:256-433-9273
Mailing Address - Street 1:1121 MAXINE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-2522
Mailing Address - Country:US
Mailing Address - Phone:260-433-9273
Mailing Address - Fax:
Practice Address - Street 1:9910 DUPONT CIRCLE DR E
Practice Address - Street 2:STE 140
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1617
Practice Address - Country:US
Practice Address - Phone:260-433-9273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001854A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health