Healthcare Provider Details

I. General information

NPI: 1285787937
Provider Name (Legal Business Name): SARA Y VELA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E STATE ST
CASSOPOLIS MI
49031-9339
US

IV. Provider business mailing address

960 E STATE ST
CASSOPOLIS MI
49031-9339
US

V. Phone/Fax

Practice location:
  • Phone: 269-445-2451
  • Fax: 269-445-3216
Mailing address:
  • Phone: 269-445-2451
  • Fax: 269-445-3216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801088788
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW0000006099
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: