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General NPI Number Information
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NPI Number | 1841015104
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Entity Type | Organization
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Legal Business Name | METAMORPHOSIS COUNSELING SERVICES
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 2924 KNIGHT ST STE 434
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City | SHREVEPORT
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State | LA
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Zip | 71105-2413
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Country | US
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Telephone | 318-208-0451
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Fax |
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Provider Business Mailing Address
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Address Line | 535 NORTHPARK DR
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2241
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Country | US
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Telephone | 318-208-0451
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH PROFESSIONAL
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Name | DR. EVELYN DERRY
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Credential | PH.D. LPC NCC
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Telephone | 318-208-0451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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