Healthcare Provider Details

I. General information

NPI: 1548106586
Provider Name (Legal Business Name): METAMORPHOSIS LIFE COACHING LOUNGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8455 OFFENHAUSER DR APT 1218
RENO NV
89511-1754
US

IV. Provider business mailing address

8455 OFFENHAUSER DR APT 1218
RENO NV
89511-1754
US

V. Phone/Fax

Practice location:
  • Phone: 916-275-4567
  • Fax:
Mailing address:
  • Phone: 916-275-4567
  • 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: DR. KEASHA WALTON-ELLIS
Title or Position: THERAPIST
Credential:
Phone: 916-275-4567