Healthcare Provider Details

I. General information

NPI: 1114467966
Provider Name (Legal Business Name): SARA MITCHELL LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 E BELTINE AVE
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

447 CHASSERAL DR NW APT 1D
COMSTOCK PARK MI
49321-9023
US

V. Phone/Fax

Practice location:
  • Phone: 616-365-0303
  • Fax:
Mailing address:
  • Phone: 616-856-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015269
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: