| Metamorphosis Life Revitalizing Center | |
|
11700 N 58th St Suite J Temple Terrace FL 33617-1666 | |
| (813) 703-2256 | |
| Not Available |
| Full Name | Metamorphosis Life Revitalizing Center |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 11700 N 58th St, Temple Terrace, Florida |
| Authorized Official Name and Position | April Michelle Jackson-james (MANAGING PARTNER) |
| Authorized Official Contact | 8137032256 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Metamorphosis Life Revitalizing Center 8430 Montravail Cir #313 Temple Terrace FL 33637-3024 Ph: (813) 703-2256 | Metamorphosis Life Revitalizing Center 11700 N 58th St Suite J Temple Terrace FL 33617-1666 Ph: (813) 703-2256 |
| NPI Number | 1356755060 |
|---|---|
| Provider Enumeration Date | 06/20/2014 |
| Last Update Date | 06/20/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356755060 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY8197 (Florida) | Primary |
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