=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043143365
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WAY TO THRIVE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2026
-----------------------------------------------------
Last Update Date | 06/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2146 DIVISION AVE S
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49507-3031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-287-5375
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2146 DIVISION AVE S
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49507-3031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-287-5375
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MALLORY WAAYENBERG
-----------------------------------------------------
Credential | MA,LLPC
-----------------------------------------------------
Telephone | 616-570-7132
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------