Healthcare Provider Details

I. General information

NPI: 1609681055
Provider Name (Legal Business Name): DEVIN FRAZIER PSYCHOLOGICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 PLYMOUTH RD STE AOFFICE1
ANN ARBOR MI
48105-9341
US

IV. Provider business mailing address

31103 ORANGELAWN ST
LIVONIA MI
48150-2926
US

V. Phone/Fax

Practice location:
  • Phone: 614-578-6317
  • Fax:
Mailing address:
  • Phone: 614-578-6317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEVIN FRAZIER
Title or Position: PRESIDENT, LICENSED PSYCHOLOGIST
Credential: PHD, LP
Phone: 614-578-6317