Provider Demographics
NPI:1326165622
Name:THE METAMORPHOSIS HOUSE
Entity Type:Organization
Organization Name:THE METAMORPHOSIS HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LSOTP
Authorized Official - Phone:512-217-6072
Mailing Address - Street 1:829 N LBJ DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4694
Mailing Address - Country:US
Mailing Address - Phone:512-217-6072
Mailing Address - Fax:512-295-4595
Practice Address - Street 1:829 N LBJ DR
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-4694
Practice Address - Country:US
Practice Address - Phone:512-217-6072
Practice Address - Fax:512-295-4595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98981101Y00000X
TX19069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty