Healthcare Provider Details

I. General information

NPI: 1639083603
Provider Name (Legal Business Name): SPIRITED PATH COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37483 GRANTLAND ST
LIVONIA MI
48150-1021
US

IV. Provider business mailing address

37483 GRANTLAND ST
LIVONIA MI
48150-1021
US

V. Phone/Fax

Practice location:
  • Phone: 313-454-1684
  • Fax:
Mailing address:
  • Phone: 313-454-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHANEL YOUSIF
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 313-454-1684