NPIMap

Organization Active NPI

Octave Behavioral Michigan, PC

  • Psychologist
  • Peachtree Corners, GA
National Provider Identifier
1477307650
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
OCTAVE BEHAVIORAL MICHIGAN, PC
Practice address
2 Sun CT Ste 400
Peachtree Corners, GA 30092-2865
Phone
(415) 360-3833
Fax
(628) 234-3048
NPI assigned
Apr 15, 2024
Last updated
Jun 26, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

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

Authorized official

Name
Kym Everett
Title
VP, Revenue Operations
Phone
(415) 360-3833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X Primary

Addresses

Primary practice location

2 Sun CT Ste 400
Peachtree Corners, GA 30092-2865

Mailing address

625 Market St FL 15
San Francisco, CA 94105-3316
Phone (415) 360-3833

Other practice location 1

1775 Parker Rd SE Ste 210
Conyers, GA 30094-6654
Phone (415) 360-3833

Other practice location 2

111 Petrol Pt Ste F
Peachtree City, GA 30269-1553
Phone (415) 360-3833

Other practice location 3

1240 Clairmont Rd Ste 100
Decatur, GA 30030-1254
Phone (415) 360-3833

Other practice location 4

111 Petrol Pt Ste A3
Peachtree City, GA 30269-1550
Phone (415) 360-3833

National Provider Directory

National Provider Directory
Tax ID family
Octave Behavioral Michigan PC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1240 Clairmont Rd
Ste 100
Decatur, GA 30030

111 Petrol Pt
Ste A3
Peachtree City, GA 30269
Phone (678) 519-0632

111 Petrol Pt
Ste F
Peachtree City, GA 30269

NPI Registry JSON

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

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750896000000",
    "number": "1477307650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 MARKET ST FL 15",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941053316",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 SUN CT STE 400",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300922865",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1775 Parker Rd SE Ste 210",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300946654",
            "country_code": "US",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 Petrol Pt Ste F",
            "address_purpose": "LOCATION",
            "city": "Peachtree City",
            "state": "GA",
            "postal_code": "302691553",
            "country_code": "US",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1240 Clairmont Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "GA",
            "postal_code": "300301254",
            "country_code": "US",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 Petrol Pt Ste A3",
            "address_purpose": "LOCATION",
            "city": "Peachtree City",
            "state": "GA",
            "postal_code": "302691550",
            "country_code": "US",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OCTAVE BEHAVIORAL MICHIGAN, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-15",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A",
        "authorized_official_last_name": "EVERETT",
        "authorized_official_first_name": "KYM",
        "authorized_official_title_or_position": "VP, REVENUE OPERATIONS",
        "authorized_official_telephone_number": "415-360-3833"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peachtree Corners, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; 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.