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General NPI Number Information
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NPI Number | 1114440633
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Entity Type | Individual
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Provider Name | LYNDA RENEE BYKERK-RUPKE LLPC
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Gender | Female
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/18/2017
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Provider Practice Location Address
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Address Line | 4467 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3776
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Country | US
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Telephone | 616-809-9451
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 FULTON ST E
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-1316
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Country | US
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Telephone | 616-808-9451
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401008164
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License Number State | MI
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