Melissa Ann Lidderdale, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301014348 Issued in MI

Practice address

1345 Monroe Ave NW Ste 252
Grand Rapids, MI 49505-4612

Phone

(616) 426-9193

NPI assigned

Mar 30, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lidderdale Consulting PLC

  • Clinical Psychologist
  • Grand Rapids, MI
  • NPI 1568080687
  Medicare reassignment NPD Authorized official
• River City Psychological Services PC

  • Clinical Psychologist
  • Grand Rapids, MI
  • NPI 1235557844
  Medicare reassignment NPD
• Lidderdale Consulting PLC

  • Psychologist
  • Grand Rapids, MI
  • NPI 1871613968
  NPD Authorized official
• Counseling Center of West Michigan, LLC

  • Mental Health Counselor
  • Grand Rapids, MI
  • NPI 1437610730
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764633600000",
    "number": "1225158306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 COURTLAND ST UNIT 794",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493415027",
            "telephone_number": "616-426-9193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 MONROE AVE NW STE 252",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495054612",
            "telephone_number": "616-426-9193"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1430 Michigan St NE Ste 7",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495032035",
            "country_code": "US",
            "telephone_number": "616-426-9193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIDDERDALE",
        "first_name": "MELISSA",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MI",
            "license": "6301014348",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301014348",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301014348",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Lichtenwalter, RN
• Ladonna G Lichterman, CRNA
• Sarah Lickiss, LMSW
• Lidderdale Consulting PLC
• Lidderdale Consulting PLC
• Amanda Liddicoat, MS, CGC
• Kelsey Lynn Liddil, OTRL
• Laken Liddle
• Jennifer Lieber
• Julie Liebknecht, MS OTR/L

• Clinical Psychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.