Provider Demographics
NPI:1720708738
Name:METAMORPHOSIS COUNSELING SERVICES
Entity Type:Organization
Organization Name:METAMORPHOSIS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS AND OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-960-2722
Mailing Address - Street 1:2829 S 118TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4305
Mailing Address - Country:US
Mailing Address - Phone:402-960-2722
Mailing Address - Fax:
Practice Address - Street 1:2829 S 118TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4305
Practice Address - Country:US
Practice Address - Phone:402-960-2722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty