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General NPI Number Information
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NPI Number | 1659238103
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Entity Type | Organization
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Legal Business Name | MOONSTONE THERAPY LLC
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 3955 DIX HWY
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City | LINCOLN PARK
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State | MI
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Zip | 48146-3939
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Country | US
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Telephone | 313-460-7376
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Fax |
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Provider Business Mailing Address
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Address Line | 7440 OAKMAN BLVD
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City | DEARBORN
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State | MI
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Zip | 48126-1529
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BOARD CERTIFIED BEHAVIOR ANALYST
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Name | FATIMA AOUDE
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Credential | M. ED., BCBA, LBA
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Telephone | 313-460-7376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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