Healthcare Provider Details

I. General information

NPI: 1053930180
Provider Name (Legal Business Name): FOCUS THERAPY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26555 EVERGREEN RD STE 870
SOUTHFIELD MI
48076-4239
US

IV. Provider business mailing address

25103 GREENBROOKE DR
SOUTHFIELD MI
48033-5283
US

V. Phone/Fax

Practice location:
  • Phone: 248-430-0594
  • Fax: 800-868-0294
Mailing address:
  • Phone: 248-470-4989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
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: MRS. SIEDAH LADONNA SPENCER-ARDIS
Title or Position: MARRIAGE & FAMILY THERAPIST
Credential: MA, LMFT
Phone: 248-470-4989