Provider Demographics
NPI:1922573989
Name:SPITSBERGEN, BRIAN EDMOND (PHD PLLC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDMOND
Last Name:SPITSBERGEN
Suffix:
Gender:M
Credentials:PHD PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24005 GILL RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3413
Mailing Address - Country:US
Mailing Address - Phone:734-564-1360
Mailing Address - Fax:
Practice Address - Street 1:24005 GILL RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-3413
Practice Address - Country:US
Practice Address - Phone:734-564-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)