Provider Demographics
NPI:1851194245
Name:FULFILLING LIFE'S YEARNINGS MENTAL HEALTH CENTER, PLLC
Entity type:Organization
Organization Name:FULFILLING LIFE'S YEARNINGS MENTAL HEALTH CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOULET
Authorized Official - Suffix:
Authorized Official - Credentials:LLC
Authorized Official - Phone:248-736-7541
Mailing Address - Street 1:5756 REVETON RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-1357
Mailing Address - Country:US
Mailing Address - Phone:248-736-7541
Mailing Address - Fax:
Practice Address - Street 1:5756 REVETON RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-1357
Practice Address - Country:US
Practice Address - Phone:248-736-7541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty