Healthcare Provider Details

I. General information

NPI: 1104468123
Provider Name (Legal Business Name): SHACARA B BURREL J.D, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 W MAIN ST
KALAMAZOO MI
49006-2954
US

IV. Provider business mailing address

PO BOX 35
OSHTEMO MI
49077-0035
US

V. Phone/Fax

Practice location:
  • Phone: 269-888-4046
  • Fax: 269-721-6361
Mailing address:
  • Phone: 231-670-9761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851105056
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801105056
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851105056
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: