Provider Demographics
NPI:1124483185
Name:BEYDOUN, LAURA MALEK (LMSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MALEK
Last Name:BEYDOUN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4826 MADDIE LN
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4173
Mailing Address - Country:US
Mailing Address - Phone:313-915-8138
Mailing Address - Fax:
Practice Address - Street 1:4826 MADDIE LN
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4173
Practice Address - Country:US
Practice Address - Phone:313-915-8138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010911411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical