Healthcare Provider Details

I. General information

NPI: 1861210676
Provider Name (Legal Business Name): METAMORPHOSIS PSYCHOLOGY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 S DEMAREE ST
VISALIA CA
93277-3934
US

IV. Provider business mailing address

PO BOX 1376
VISALIA CA
93279-1376
US

V. Phone/Fax

Practice location:
  • Phone: 559-360-7677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. BETH COKE
Title or Position: OWNER
Credential: PHD
Phone: 559-360-7677