Provider Demographics
NPI:1104468123
Name:BURREL, SHACARA B (JD, MSW,LLMSW)
Entity type:Individual
Prefix:
First Name:SHACARA
Middle Name:B
Last Name:BURREL
Suffix:
Gender:F
Credentials:JD, MSW,LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:OSHTEMO
Mailing Address - State:MI
Mailing Address - Zip Code:49077-0035
Mailing Address - Country:US
Mailing Address - Phone:231-670-9761
Mailing Address - Fax:
Practice Address - Street 1:2970 S 9TH ST STE 9
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9493
Practice Address - Country:US
Practice Address - Phone:269-888-4046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511050561041C0700X, 104100000X
MI68011050561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801105056OtherMSW LIMITED LICENSE
MI6851105056OtherLLMSW