Provider Demographics
NPI:1316727381
Name:METAMORPHOSIS
Entity type:Organization
Organization Name:METAMORPHOSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, QMHP
Authorized Official - Phone:605-650-2079
Mailing Address - Street 1:622 S MINNESOTA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-4881
Mailing Address - Country:US
Mailing Address - Phone:605-650-2079
Mailing Address - Fax:
Practice Address - Street 1:622 S MINNESOTA AVE STE 103
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-4881
Practice Address - Country:US
Practice Address - Phone:605-650-2079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty