Provider Demographics
NPI:1568080687
Name:LIDDERDALE CONSULTING PLC
Entity Type:Organization
Organization Name:LIDDERDALE CONSULTING PLC
Other - Org Name:MELISSA A. LIDDERDALE PLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LIDDERDALE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:616-426-9193
Mailing Address - Street 1:57 COURTLAND ST UNIT 794
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-5027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:668 3 MILE RD NW STE D
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8219
Practice Address - Country:US
Practice Address - Phone:616-426-9193
Practice Address - Fax:616-426-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty