Provider Demographics
NPI:1558787473
Name:BEYDOUN, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:BEYDOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RON
Other - Middle Name:
Other - Last Name:BEYDOUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:38219 MOUND RD STE 102
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3466
Mailing Address - Country:US
Mailing Address - Phone:586-939-5016
Mailing Address - Fax:586-939-5194
Practice Address - Street 1:38219 MOUND RD STE 102
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3466
Practice Address - Country:US
Practice Address - Phone:586-939-5016
Practice Address - Fax:586-939-5194
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171M00000X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical