Healthcare Provider Details

I. General information

NPI: 1487565180
Provider Name (Legal Business Name): LIV THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 BURTON ST SE
GRAND RAPIDS MI
49546-4809
US

IV. Provider business mailing address

625 KENMOOR AVE SE STE 350
GRAND RAPIDS MI
49546-2395
US

V. Phone/Fax

Practice location:
  • Phone: 616-287-5007
  • Fax:
Mailing address:
  • Phone: 616-287-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. OLIVIA BRENNINKMEIJER
Title or Position: OWNER/PROVIDER
Credential: MA, LPC, NCC
Phone: 616-287-5007