Healthcare Provider Details

I. General information

NPI: 1477281707
Provider Name (Legal Business Name): MONA M BAYDOUN I MA,LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONA M BAYDOUN I MA,LLPC

II. Dates (important events)

Enumeration Date: 08/14/2022
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKLANE BLVD
DEARBORN MI
48126-2400
US

IV. Provider business mailing address

6218 STEADMAN ST
DEARBORN MI
48126-2055
US

V. Phone/Fax

Practice location:
  • Phone: 313-846-2606
  • Fax: 313-846-2657
Mailing address:
  • Phone: 313-265-6382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451022440
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: