Provider Demographics
NPI:1730974189
Name:MONFORD, LAYA SIMONE
Entity type:Individual
Prefix:
First Name:LAYA
Middle Name:SIMONE
Last Name:MONFORD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 N MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2829
Mailing Address - Country:US
Mailing Address - Phone:734-833-3684
Mailing Address - Fax:
Practice Address - Street 1:697 N MAPLE RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2829
Practice Address - Country:US
Practice Address - Phone:734-833-3684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0023666708Medicaid