Organization
FULLY ALIVE THERAPEUTIC SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN SPIZARNY LMSW (OWNER)
(248) 983-3440
Entity
Organization
Contact information
Practice address
32910 W 13 MILE RD STE D-402, FARMINGTON HILLS, MI 48334-1980
(313) 530-7916
Mailing address
26350 KILTARTAN ST, FARMINGTON HILLS, MI 48334-4834
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
10/09/2020
Last updated
01/31/2021
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