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General NPI Number Information
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NPI Number | 1528794807
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Entity Type | Organization
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Legal Business Name | METAMORPHOSIS PSYCHCIERGE LLC
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 401 E LAS OLAS BLVD STE 1400
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-2218
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Country | US
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Telephone | 313-949-9467
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Fax |
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Provider Business Mailing Address
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Address Line | 4920 SHALIMAR LN APT 4109
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City | DAVIE
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State | FL
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Zip | 33328-7171
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Country | US
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Telephone | 313-949-9467
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | DR. JASMINE MOORE
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Credential | DNP, APRN
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Telephone | 313-949-9467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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