NPIMap

Organization Active NPI

Metamorphosis Counseling and Health Center of Idaho, LLC

  • Peer Specialist
  • Boise, ID
National Provider Identifier
1043088511
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
Legal business name
METAMORPHOSIS COUNSELING AND HEALTH CENTER OF IDAHO, LLC
Practice address
10108 W Overland Rd Ste a
Boise, ID 83709-1428
Phone
(208) 376-1532
Fax
(208) 375-7251
NPI assigned
Dec 14, 2023
Organization subpart
Yes
Parent organization
1235791997As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Crystal Michelle Miller, BS
Title
Executive Director
Phone
(208) 890-6205

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Peer SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 175T00000X Primary

Addresses

Primary practice location

10108 W Overland Rd Ste a
Boise, ID 83709-1428

Mailing address

10108 W Overland Rd Ste a
Boise, ID 83709-1428
Phone (208) 890-6205

National Provider Directory

National Provider Directory
Tax ID family
Metamorphosis Counseling and Health Center of Idaho LLC5 organizations share this tax ID, including this one
Part of
Metamorphosis Counseling and Health Center of Idaho LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702512000000",
    "number": "1043088511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10108 W OVERLAND RD STE A",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091428",
            "telephone_number": "208-890-6205",
            "fax_number": "208-375-7251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10108 W OVERLAND RD STE A",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091428",
            "telephone_number": "208-376-1532",
            "fax_number": "208-375-7251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METAMORPHOSIS COUNSELING AND HEALTH CENTER OF IDAHO, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "1235791997",
        "enumeration_date": "2023-12-14",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "208-890-6205",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.