Healthcare Provider Details

I. General information

NPI: 1558208785
Provider Name (Legal Business Name): MICHAEL E CALLENDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 S MALACHITE AVE
MERIDIAN ID
83642-6394
US

IV. Provider business mailing address

799 S MALACHITE AVE
MERIDIAN ID
83642-6394
US

V. Phone/Fax

Practice location:
  • Phone: 208-350-6759
  • Fax:
Mailing address:
  • Phone: 208-350-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SARAH JANE SHARP
Title or Position: OFFICE MANAGER
Credential:
Phone: 208-996-3542