Healthcare Provider Details

I. General information

NPI: 1114440633
Provider Name (Legal Business Name): LYNDA RENEE BYKERK-RUPKE LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4467 CASCADE RD SE
GRAND RAPIDS MI
49546-3776
US

IV. Provider business mailing address

3401 FULTON ST E
GRAND RAPIDS MI
49546-1316
US

V. Phone/Fax

Practice location:
  • Phone: 616-809-9451
  • Fax:
Mailing address:
  • Phone: 616-808-9451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008164
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: