Healthcare Provider Details

I. General information

NPI: 1386192409
Provider Name (Legal Business Name): REBECCA GOMEZ DE TUINSTRA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2016
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date: 01/08/2025
Reactivation Date: 01/29/2025

III. Provider practice location address

6500 BYRON CENTER AVE SW STE 300
BYRON CENTER MI
49315-9083
US

IV. Provider business mailing address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

V. Phone/Fax

Practice location:
  • Phone: 616-281-6382
  • Fax: 616-281-6397
Mailing address:
  • Phone: 616-455-5000
  • Fax: 616-455-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361007294
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301016879
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301019583
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019583
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: