Active NPI
Candice Tudor
- Psychologist
- Grand Rapids, MI
National Provider Identifier
1972440816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6362009738
- Practice address
- 300 68TH St SE
Grand Rapids, MI 49548-6927 - Phone
- (616) 455-5000
- Fax
- (616) 281-6459
- NPI assigned
- Apr 29, 2026
- Sex
- Unspecified or another gender identity
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6362009738 | MI | Primary |
Addresses
Primary practice location
300 68TH St SE
Grand Rapids, MI 49548-6927
Mailing address
300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000
Other practice location 1
1870 Leonard St NE
Grand Rapids, MI 49505-5650
Phone (616) 956-1122
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6362009738 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1777420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782086400000",
"number": "1972440816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 68TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495486927",
"telephone_number": "616-455-5000",
"fax_number": "616-281-6459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 68TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495486927",
"telephone_number": "616-455-5000",
"fax_number": "616-281-6459"
}
],
"practiceLocations": [
{
"address_1": "1870 Leonard St NE",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495055650",
"country_code": "US",
"telephone_number": "616-956-1122",
"fax_number": "616-956-5650",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TUDOR",
"first_name": "CANDICE",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2026-04-29",
"last_updated": "2026-06-22",
"certification_date": "2026-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6362009738",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.