Individual
AUSTIN JEROME MALONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
4905 MELTON RD, GARY, IN 46403-2873
(219) 808-0793
(765) 374-0761
Mailing address
222 INDIANAPOLIS BLVD STE 207, SCHERERVILLE, IN 46375-1275
(219) 808-0793
(765) 274-0621
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39003046A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300014409
—
IN
Enumeration date
07/02/2018
Last updated
07/02/2018
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