{"npi":"1730143553","type":"NPI-2","status":"active","name":{"display":"Moon River, LLC","other":[],"organization_name":"MOON RIVER, LLC","authorised_official":"Laura Desantis"},"specialty":{"primary_taxonomy":"103K00000X","primary_taxonomy_description":"Behavior Analyst","slug":"behavior-analyst","schema_org_specialty":null,"all":[{"code":"103T00000X","description":"Psychologist","primary":false,"state":null,"license":null},{"code":"225100000X","description":"Physical Therapist","primary":false,"state":"GA","license":"PT003833"},{"code":"225XP0200X","description":"Pediatric Occupational Therapist","primary":false,"state":"GA","license":"OT 004293"},{"code":"225XP0200X","description":"Pediatric Occupational Therapist","primary":false,"state":"GA","license":"GAOT001717"},{"code":"235Z00000X","description":"Speech-Language Pathology","primary":false,"state":"GA","license":"SLP003992"},{"code":"235Z00000X","description":"Speech-Language Pathology","primary":false,"state":"GA","license":"SLP005806"},{"code":"235Z00000X","description":"Speech-Language Pathology","primary":false,"state":"GA","license":"SLP006528"},{"code":"235Z00000X","description":"Speech-Language Pathology","primary":false,"state":"GA","license":"SLP 06551"},{"code":"235Z00000X","description":"Speech-Language Pathology","primary":false,"state":"GA","license":"SLP 006556"},{"code":"103K00000X","description":"Behavior Analyst","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"790 OAK TRAIL DR","city":"MARIETTA","state":"GA","postal_code":"300627502","country_code":"US","phone":"7709776866","fax":"7709776887"},{"purpose":"MAILING","street_1":"790 OAK TRAIL DR","city":"MARIETTA","state":"GA","postal_code":"300627502","country_code":"US","phone":"7702122170","fax":"7707838639"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"000970835A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"317872221A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"503885675B","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"315889908A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"339518223A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"516643175A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"761415888A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"765677599A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"814363142A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"188883028B","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"426315361A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"000753563E","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"191707573A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"461168837A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"481436178B","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"000860736B","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"240960806A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"850524466A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"146855825A","state":"GA","issuer":null},{"type_code":"05","label":"Medicaid","value":"986209149B","state":"GA","issuer":null}],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2006-04-17","last_updated":"2025-02-18","_meta":{"source":"NPPES","snapshot_date":"2025-02-18","doc_url":"https://findmynpi.com/api"}}