Provider Demographics
NPI:1023504198
Name:MALONE, AUSTIN JEROME (LMHC)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JEROME
Last Name:MALONE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 INDIANAPOLIS BLVD 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:219-808-0793
Mailing Address - Fax:765-274-0621
Practice Address - Street 1:4905 MELTON RD
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-2873
Practice Address - Country:US
Practice Address - Phone:219-808-0793
Practice Address - Fax:765-374-0761
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003046A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300014409Medicaid