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General NPI Number Information
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NPI Number | 1053858365
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Entity Type | Organization
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Legal Business Name | METAMORPHOSIS PSYCHOTHERAPY & COUNSELING
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 4008 LADY PALM CT
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City | TAMPA
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State | FL
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Zip | 33624-2383
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Country | US
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Telephone | 813-777-7407
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Fax |
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Provider Business Mailing Address
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Address Line | 4008 LADY PALM CT
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City | TAMPA
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State | FL
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Zip | 33624-2383
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Country | US
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Telephone | 813-777-7407
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | JENNIFER BETANCUR
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Credential | LCSW
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Telephone | 813-777-7407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SW12475
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License Number State | FL
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