Organization
METAMORPHOSIS COUNSELING AND HEALTH CENTER OF IDAHO, LLC
Active
Parent organization
1235791997
Organization subpart
Yes
Provider details
NPI number
Legal business name
1235791997
Authorized official
MRS. CRYSTAL MICHELLE MILLER BS (EXECUTIVE DIRECTOR/OWNER)
(208) 376-1532
Entity
Organization
Contact information
Practice address
10108 W OVERLAND RD # A, BOISE, ID 83709-1428
(208) 376-1532
(208) 375-7251
Mailing address
10108 W OVERLAND RD # A, BOISE, ID 83709-1428
(208) 376-1532
(208) 375-7251
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
601398110
—
ID
Enumeration date
07/02/2019
Last updated
11/19/2025
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