Provider Demographics
NPI:1598169278
Name:BAYOUK, RENEA RISHMAWI (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:RENEA
Middle Name:RISHMAWI
Last Name:BAYOUK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757 ROLLING HILLS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1486
Mailing Address - Country:US
Mailing Address - Phone:810-624-9527
Mailing Address - Fax:
Practice Address - Street 1:450 N OLD WOODWARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-5361
Practice Address - Country:US
Practice Address - Phone:248-792-8273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014885101Y00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3434247Medicaid