Provider Demographics
NPI:1407496516
Name:MEREDITH, LIZA N (PHD)
Entity Type:Individual
Prefix:DR
First Name:LIZA
Middle Name:N
Last Name:MEREDITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E DIAMOND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1457
Mailing Address - Country:US
Mailing Address - Phone:608-658-9037
Mailing Address - Fax:
Practice Address - Street 1:ACACIA COUNSELING AND WELLNESS
Practice Address - Street 2:2724 UNIVERSITY AVE SE UNIT B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414
Practice Address - Country:US
Practice Address - Phone:612-299-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6233103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist