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General NPI Number Information
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NPI Number | 1114849023
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Entity Type | Organization
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Legal Business Name | METAMORPHOSIS MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 07/30/2026
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Last Update Date | 07/30/2026
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Provider Practice Location Address
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Address Line | 412 HAWK RD
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City | MEDFORD
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State | OR
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Zip | 97501-8556
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Country | US
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Telephone | 541-517-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 5441 S MACADAM AVE STE N
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City | PORTLAND
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State | OR
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Zip | 97239-3822
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRITTANY WALL
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Credential | PMHNP
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Telephone | 541-517-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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