Healthcare Provider Details

I. General information

NPI: 1043143365
Provider Name (Legal Business Name): WAY TO THRIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 DIVISION AVE S
GRAND RAPIDS MI
49507-3031
US

IV. Provider business mailing address

2146 DIVISION AVE S
GRAND RAPIDS MI
49507-3031
US

V. Phone/Fax

Practice location:
  • Phone: 616-287-5375
  • Fax:
Mailing address:
  • Phone: 616-287-5375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MALLORY WAAYENBERG
Title or Position: OWNER
Credential: MA,LLPC
Phone: 616-570-7132