Provider Demographics
NPI:1194201384
Name:METAMORPHOSIS MENTAL HEALTH FAMILY CENTER, LLC
Entity Type:Organization
Organization Name:METAMORPHOSIS MENTAL HEALTH FAMILY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:863-438-6806
Mailing Address - Street 1:1145 N PLATTE LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-5969
Mailing Address - Country:US
Mailing Address - Phone:407-346-9898
Mailing Address - Fax:
Practice Address - Street 1:28019 HWY 27 STE C
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4437
Practice Address - Country:US
Practice Address - Phone:863-438-6806
Practice Address - Fax:863-582-9396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health