Healthcare Provider Details

I. General information

NPI: 1376465682
Provider Name (Legal Business Name): MICHAELA GEORGE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 S EAGLE RD
MERIDIAN ID
83642-6707
US

IV. Provider business mailing address

3800 E MOON DIPPER ST
MERIDIAN ID
83642-7338
US

V. Phone/Fax

Practice location:
  • Phone: 208-340-1688
  • Fax:
Mailing address:
  • Phone: 208-340-1688
  • Fax: 208-887-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: