Provider Demographics
NPI:1821519299
Name:AL-MUGOTIR, HEBA (LPC)
Entity Type:Individual
Prefix:
First Name:HEBA
Middle Name:
Last Name:AL-MUGOTIR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 SAULINO CT
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1556
Mailing Address - Country:US
Mailing Address - Phone:138-427-0103
Mailing Address - Fax:313-842-5150
Practice Address - Street 1:6451 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2212
Practice Address - Country:US
Practice Address - Phone:313-945-8138
Practice Address - Fax:313-203-3390
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI64010203361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician