Provider Demographics
NPI:1841015104
Name:METAMORPHOSIS COUNSELING SERVICES
Entity type:Organization
Organization Name:METAMORPHOSIS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH PROFESSIONAL
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LPC NCC
Authorized Official - Phone:318-208-0451
Mailing Address - Street 1:535 NORTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2241
Mailing Address - Country:US
Mailing Address - Phone:318-208-0451
Mailing Address - Fax:
Practice Address - Street 1:2924 KNIGHT ST STE 434
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2413
Practice Address - Country:US
Practice Address - Phone:318-208-0451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVELYN DERRY MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty