Provider Demographics
NPI:1245787241
Name:WAYBRANT, NATALIE (LMFT)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:WAYBRANT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:DR
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:SENATORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:4931 CEDAR RIDGE ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1210
Mailing Address - Country:US
Mailing Address - Phone:847-567-6642
Mailing Address - Fax:
Practice Address - Street 1:1971 E BELTLINE AVE NE STE 200-C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7045
Practice Address - Country:US
Practice Address - Phone:616-344-1344
Practice Address - Fax:616-344-1100
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4101006701OtherLICENSE