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General NPI Number Information
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NPI Number | 1861210676
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Entity Type | Organization
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Legal Business Name | METAMORPHOSIS PSYCHOLOGY GROUP INC
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 1702 S DEMAREE ST
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City | VISALIA
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State | CA
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Zip | 93277-3934
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Country | US
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Telephone | 559-360-7677
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1376
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City | VISALIA
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State | CA
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Zip | 93279-1376
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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 | DR. BETH COKE
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Credential | PHD
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Telephone | 559-360-7677
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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