Provider Demographics
NPI:1477281707
Name:BAYDOUN, MONA M I (MA,LLPC)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:M
Last Name:BAYDOUN
Suffix:I
Gender:F
Credentials:MA,LLPC
Other - Prefix:MS
Other - First Name:MONA
Other - Middle Name:M
Other - Last Name:BAYDOUN
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MA,LLPC
Mailing Address - Street 1:6218 STEADMAN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2055
Mailing Address - Country:US
Mailing Address - Phone:313-265-6382
Mailing Address - Fax:
Practice Address - Street 1:1 PARKLANE BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2400
Practice Address - Country:US
Practice Address - Phone:313-846-2606
Practice Address - Fax:313-846-2657
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI651022440Medicaid
MI64511022440OtherCOUNSELING LICENSE