=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821964172
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METAMORPH KIDS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2025
-----------------------------------------------------
Last Update Date | 10/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1014 DAISY ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77012-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-657-4518
-----------------------------------------------------
Fax | 504-657-4518
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1014 DAISY ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77012-2910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-657-4518
-----------------------------------------------------
Fax | 504-657-4518
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. COURTNI DOBBINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-657-4518
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------