NPIMap

Organization Active NPI

Life Fully Lived, LLC

  • Mental Health Counselor
  • Talleyville, DE
National Provider Identifier
1003408352
Registry record updated Dec 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
LIFE FULLY LIVED, LLC
Practice address
19 Brandywine Blvd
Talleyville, DE 19803-1838
Phone
(302) 703-7779
NPI assigned
Feb 8, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2023

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

Authorized official

Name
Megan Doyle, LPCMHNPI 1023361136
Title
Owner
Phone
(443) 466-7038

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

19 Brandywine Blvd
Talleyville, DE 19803-1838

Mailing address

19 Brandywine Blvd
Talleyville, DE 19803-1838
Phone (302) 703-7779

Other practice location 1

425 Stafford Ave
Newark, DE 19711-5575
Phone (443) 466-7038

Other identifiers 9

IdentifierTypeStateIssuer
1366405433MedicaidDE
1124693056MedicaidDE
1538734959MedicaidDE
1275287823MedicaidDE
1023361136MedicaidDE
1134272610MedicaidDE
1891379467MedicaidDE
1093300527MedicaidDE
1134488711MedicaidDE

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address administrator@lifefullylived.hush.com Direct
Direct Messaging Address administrator@lifefullylived.hush.com Direct

National Provider Directory

National Provider Directory

Locations

7209 Lancaster Pike
Ste 41193
Hockessin, DE 19707

3524 Silverside Rd
Ste 34
Wilmington, DE 19810
Phone (610) 306-5637

Practitioners & affiliated clinicians

Practitioners 9

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": "1612742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703376000000",
    "number": "1003408352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 BRANDYWINE BLVD",
            "city": "TALLEYVILLE",
            "state": "DE",
            "postal_code": "198031838",
            "telephone_number": "302-703-7779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 BRANDYWINE BLVD",
            "city": "TALLEYVILLE",
            "state": "DE",
            "postal_code": "198031838",
            "telephone_number": "302-703-7779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "425 Stafford Ave",
            "address_purpose": "LOCATION",
            "city": "Newark",
            "state": "DE",
            "postal_code": "197115575",
            "country_code": "US",
            "telephone_number": "443-466-7038",
            "fax_number": "302-337-5986",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFE FULLY LIVED, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-08",
        "last_updated": "2023-12-24",
        "certification_date": "2023-12-24",
        "status": "A",
        "authorized_official_last_name": "DOYLE",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-466-7038",
        "authorized_official_credential": "LPCMH"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366405433",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124693056",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538734959",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275287823",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023361136",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134272610",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891379467",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093300527",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134488711",
            "state": "DE"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "administrator@lifefullylived.hush.com",
            "affiliation": "N",
            "endpointDescription": "HIPPA Compliant Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "425 Stafford Ave Ste 4",
            "city": "Newark",
            "state": "DE",
            "country_code": "US",
            "postal_code": "197115575",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "administrator@lifefullylived.hush.com",
            "affiliation": "N",
            "endpointDescription": "Encrypted HIPPA complaint and secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "425 Stafford Ave",
            "city": "Newark",
            "state": "DE",
            "country_code": "US",
            "postal_code": "197115575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Talleyville, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 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.