Healthcare Provider Details

I. General information

NPI: 1528902665
Provider Name (Legal Business Name): MEGHAN MCCALLISTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 PROVIDENCE MINE RD STE 204
NEVADA CITY CA
95959-2949
US

IV. Provider business mailing address

15329 LITTLE VALLEY RD SPC 88
GRASS VALLEY CA
95949-6869
US

V. Phone/Fax

Practice location:
  • Phone: 530-264-8155
  • Fax:
Mailing address:
  • Phone: 831-840-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: