| Lidderdale Consulting Plc | |
|
1345 Monroe Ave Nw Ste 252 Grand Rapids MI 49505-4612 | |
| (616) 426-9193 | |
| Not Available |
| Full Name | Lidderdale Consulting Plc |
|---|---|
| Speciality | Psychologist |
| Location | 1345 Monroe Ave Nw Ste 252, Grand Rapids, Michigan |
| Authorized Official Name and Position | Melissa Ann Lidderdale (PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 6164269193 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lidderdale Consulting Plc 57 Courtland St Unit 794 Rockford MI 49341-5027 Ph: () - | Lidderdale Consulting Plc 1345 Monroe Ave Nw Ste 252 Grand Rapids MI 49505-4612 Ph: (616) 426-9193 |
| NPI Number | 1568080687 |
|---|---|
| Provider Enumeration Date | 07/07/2020 |
| Last Update Date | 05/30/2024 |
| Certification Date | 05/30/2024 |
| Medicare PECOS PAC ID | 4688094493 |
|---|---|
| Medicare Enrollment ID | O20201016000930 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568080687 | NPI | - | NPPES |
| Provider Name | Melissa Lidderdale |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225158306 PECOS PAC ID: 4789835398 Enrollment ID: I20121107000743 |
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