Provider Demographics
NPI:1699076364
Name:METAMORPHOSIS COUNSELING CENTER, LLC.
Entity type:Organization
Organization Name:METAMORPHOSIS COUNSELING CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DEMARS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-993-8301
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70727-1387
Mailing Address - Country:US
Mailing Address - Phone:225-993-8301
Mailing Address - Fax:225-243-7652
Practice Address - Street 1:1457 4H CLUB RD
Practice Address - Street 2:SUITE C
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4972
Practice Address - Country:US
Practice Address - Phone:225-993-8301
Practice Address - Fax:225-243-7652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1407925431OtherBLUE CROSS/BLUE SHIELD
LA12165803OtherAETNA