Healthcare Provider Details

I. General information

NPI: 1114849023
Provider Name (Legal Business Name): METAMORPHOSIS MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 HAWK RD
MEDFORD OR
97501-8556
US

IV. Provider business mailing address

5441 S MACADAM AVE STE N
PORTLAND OR
97239-3822
US

V. Phone/Fax

Practice location:
  • Phone: 541-517-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY WALL
Title or Position: OWNER
Credential: PMHNP
Phone: 541-517-1111