Healthcare Provider Details

I. General information

NPI: 1861167900
Provider Name (Legal Business Name): METAMORPHOSIS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MARQUEZ PL STE D5
SANTA FE NM
87505-1724
US

IV. Provider business mailing address

1003 DON JUAN ST
SANTA FE NM
87501-2411
US

V. Phone/Fax

Practice location:
  • Phone: 530-953-8876
  • Fax:
Mailing address:
  • Phone: 530-953-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MS. MELODY VAN HOOSE
Title or Position: OWNER
Credential: LPCC
Phone: 530-953-8876