Living Fully Psychotherapy and Consulting, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

PSY003405 Issued in GA

Legal business name

LIVING FULLY PSYCHOTHERAPY AND CONSULTING, LLC

Practice address

1463 Oxford Rd NE
Atlanta, GA 30322-1046

Phone

(678) 591-9117

NPI assigned

Dec 20, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Pegah Moghaddam, PSY.D.

Title

Owner/Director

Phone

(678) 591-9117

Specialties & licenses 1

Addresses

Other names 1

• Living Fully Other name

Locations

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

{
    "created_epoch": "1387497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387497600000",
    "number": "1215358015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 COBBLESTONE TRL",
            "city": "AVONDALE ESTATES",
            "state": "GA",
            "postal_code": "300021211",
            "telephone_number": "678-591-9117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1463 OXFORD RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221046",
            "telephone_number": "678-591-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING FULLY PSYCHOTHERAPY AND CONSULTING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-20",
        "last_updated": "2013-12-20",
        "status": "A",
        "authorized_official_last_name": "MOGHADDAM",
        "authorized_official_first_name": "PEGAH",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "678-591-9117",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "GA",
            "license": "PSY003405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Living Fully",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2013; 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.