Fully Alive Therapeutic Services, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

FULLY ALIVE THERAPEUTIC SERVICES, LLC

Practice address

32910 W 13 Mile Rd Ste D-402
Farmington Hills, MI 48334-1980

Phone

(313) 530-7916

NPI assigned

Oct 9, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin Spizarny, LMSWNPI 1679827653

Title

Owner

Phone

(248) 983-3440

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin James Spizarny, LMSW

  • Clinical Social Worker
  • Westland, MI
  • NPI 1679827653
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612051200000",
    "number": "1477151751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26350 KILTARTAN ST",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483344834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32910 W 13 MILE RD STE D-402",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483341980",
            "telephone_number": "313-530-7916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLY ALIVE THERAPEUTIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-09",
        "last_updated": "2021-01-31",
        "certification_date": "2021-01-31",
        "status": "A",
        "authorized_official_last_name": "SPIZARNY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-983-3440",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Quiniece Fuller
• Sade Fuller
• Shakeira Fuller
• Shelby Fullerton
• Tiffany Fullerton
• Ashley Fullylove
• Robin Fulson
• Ashley Fulton, DO
• Chloe Fulton
• Mya Fulton

• Adult Mental Health Clinic/Center in Farmington Hills, MI
• Providers in Farmington Hills, MI by specialty
• Adult Mental Health Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.