Provider Demographics
NPI:1861167900
Name:METAMORPHOSIS COUNSELING LLC
Entity type:Organization
Organization Name:METAMORPHOSIS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:530-953-8876
Mailing Address - Street 1:1003 DON JUAN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2411
Mailing Address - Country:US
Mailing Address - Phone:530-953-8876
Mailing Address - Fax:
Practice Address - Street 1:1010 MARQUEZ PL STE D5
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1724
Practice Address - Country:US
Practice Address - Phone:530-953-8876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty