1477281707 NPI number — MS. MONA M BAYDOUN I MA,LLPC

Table of content: MS. MONA M BAYDOUN I MA,LLPC (NPI 1477281707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477281707 NPI number — MS. MONA M BAYDOUN I MA,LLPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAYDOUN
Provider First Name:
MONA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
I
Provider Credential Text:
MA,LLPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAYDOUN
Provider Other First Name:
MONA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
MA,LLPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1477281707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6218 STEADMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48126-2055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-265-6382
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PARKLANE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48126-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-846-2606
Provider Business Practice Location Address Fax Number:
313-846-2657
Provider Enumeration Date:
08/14/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  6451022440 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 651022440 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64511022440 . This is a "COUNSELING LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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