Provider Demographics
NPI:1376986588
Name:VEATCH, MISTY M (LMSW)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:M
Last Name:VEATCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:M
Other - Last Name:TESSENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:134 W MAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1559
Mailing Address - Country:US
Mailing Address - Phone:810-874-0420
Mailing Address - Fax:
Practice Address - Street 1:134 W MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1559
Practice Address - Country:US
Practice Address - Phone:810-874-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI241220405031041C0700X
MI6801086844171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical