Healthcare Provider Details

I. General information

NPI: 1871402214
Provider Name (Legal Business Name): MELISSA LIU PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10590 WAYZATA BLVD STE 160
MINNETONKA MN
55305-5531
US

IV. Provider business mailing address

2841 BRYANT AVE S APT 110
MINNEAPOLIS MN
55408-2575
US

V. Phone/Fax

Practice location:
  • Phone: 651-505-3273
  • Fax:
Mailing address:
  • Phone: 443-642-8169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: