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General NPI Number Information
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NPI Number | 1245787241
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Entity Type | Individual
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Provider Name | NATALIE WAYBRANT LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 1971 E BELTLINE AVE NE STE 200-C
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-7045
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Country | US
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Telephone | 616-344-1344
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Fax | 616-344-1100
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Provider Business Mailing Address
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Address Line | 4931 CEDAR RIDGE ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1210
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Country | US
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Telephone | 847-567-6642
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101006701
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License Number State | MI
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