Organization Active NPI

Metamorphosis Mental Health, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Medford, OR
National Provider Identifier
1114849023
Registry record updated Jul 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
METAMORPHOSIS MENTAL HEALTH, LLC
Practice address
412 Hawk Rd
Medford, OR 97501-8556
Phone
(541) 517-1111
NPI assigned
Jul 30, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2026

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

Authorized official

Name
Brittany Wall, PMHNPNPI 1659239838
Title
Owner
Phone
(541) 517-1111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

412 Hawk Rd
Medford, OR 97501-8556

Mailing address

5441 S Macadam Ave Ste N
Portland, OR 97239-3822

Other practice location 1

809 E Jackson St
Medford, OR 97504-6713
Phone (541) 245-3614

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1785369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785369600000",
    "number": "1114849023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5441 S MACADAM AVE STE N",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 HAWK RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975018556",
            "telephone_number": "541-517-1111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "809 E Jackson St",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "975046713",
            "country_code": "US",
            "telephone_number": "541-245-3614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "METAMORPHOSIS MENTAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-30",
        "last_updated": "2026-07-30",
        "certification_date": "2026-07-29",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "BRITTANY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-517-1111",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2026; 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.