Healthcare Provider Details

I. General information

NPI: 1073149175
Provider Name (Legal Business Name): REBECCA LYNN MAY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 3 MILE RD NW STE 1
GRAND RAPIDS MI
49544-8220
US

IV. Provider business mailing address

1558 LEXINGTON AVE
MUSKEGON MI
49441-3126
US

V. Phone/Fax

Practice location:
  • Phone: 616-287-3112
  • Fax:
Mailing address:
  • Phone: 616-550-1743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401018158
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401018158
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401018158
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: