Provider Demographics
NPI:1396135026
Name:MAKKI, MONA
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:MAKKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31700 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-3407
Mailing Address - Country:US
Mailing Address - Phone:248-220-4950
Mailing Address - Fax:855-975-2420
Practice Address - Street 1:31700 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-3407
Practice Address - Country:US
Practice Address - Phone:248-220-4950
Practice Address - Fax:855-975-2420
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MI6361005127103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health