Organization Active NPI

Moon River, LLC

Behavior Analyst
Marietta, GA

National Provider Identifier

1730143553

Registry record updated Feb 18, 2025

On this page

Key facts
NPPES NPI Registry
National Provider Directory
Practitioners & affiliated clinicians
NPI Registry JSON
Other providers in Marietta, GA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Behavior AnalystTaxonomy code 103K00000X
Legal business name: MOON RIVER, LLC
Practice address: 790 Oak Trail Dr
Marietta, GA 30062-7502
Phone: (770) 977-6866
Fax: (770) 977-6887
NPI assigned: Apr 17, 2006
Organization subpart: No

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

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

Authorized official

Name: Laura Desantis
Title: Office Manager
Phone: (770) 212-2170

Specialties & licenses 10

Specialty (taxonomy)	Code	License	State	Primary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP	103K00000X			Primary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP	103T00000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP	225100000X	PT003833	GA
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP	225XP0200X	OT 004293	GA
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP	225XP0200X	GAOT001717	GA
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP	235Z00000X	SLP003992	GA
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP	235Z00000X	SLP005806	GA
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP	235Z00000X	SLP006528	GA
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP	235Z00000X	SLP 06551	GA
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP	235Z00000X	SLP 006556	GA

Addresses

Primary practice location

790 Oak Trail Dr
Marietta, GA 30062-7502

Mailing address

790 Oak Trail Dr
Marietta, GA 30062-7502
Phone (770) 212-2170

Other identifiers 20

Identifier	Type	State
000970835A	Medicaid	GA
317872221A	Medicaid	GA
503885675B	Medicaid	GA
315889908A	Medicaid	GA
339518223A	Medicaid	GA
516643175A	Medicaid	GA
761415888A	Medicaid	GA
765677599A	Medicaid	GA
814363142A	Medicaid	GA
188883028B	Medicaid	GA
426315361A	Medicaid	GA
000753563E	Medicaid	GA
191707573A	Medicaid	GA
461168837A	Medicaid	GA
481436178B	Medicaid	GA
000860736B	Medicaid	GA
240960806A	Medicaid	GA
850524466A	Medicaid	GA
146855825A	Medicaid	GA
986209149B	Medicaid	GA

National Provider Directory

Locations

3470 Florence Rd
Powder Springs, GA 30127
Phone (770) 212-2170

7440 Highway 92
Woodstock, GA 30189
Phone (770) 212-2170

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Shequila D Beamer, MS - SLP
- Speech-Language Pathologist
- Woodstock, GA
- NPI 1093395824
NPD
Lauren Brougher, OTD
- Occupational Therapist
- Roswell, GA
- NPI 1902658180
NPD
Shellie R Davis, CCC-SLP
- Speech-Language Pathologist
- Marietta, GA
- NPI 1962051979
NPD
Dimitri Defrant, DPT
- Physical Therapist
- Woodstock, GA
- NPI 1184238040
Multi-Specialty
NPD
Amanda Marie Galagarza, SLP-CLINICAL FELLOW
- Student in an Organized Health Care Education/Training Program
- Woodstock, GA
- NPI 1730819343
Single Specialty
NPD
Shelby Gooden
- Behavior Analyst
- Woodstock, GA
- NPI 1104412840
NPD
Kyrei Jendaya Miller, OTR/L
- Occupational Therapist
- Woodstock, GA
- NPI 1851127310
NPD
Denise Williams Watson
- Case Manager/Care Coordinator
- Marietta, GA
- NPI 1760263271
Multi-Specialty
NPD
Hannah M Shirah, DPT
- Physical Therapist
- Aiken, SC
- NPI 1003421223
Multi-Specialty
NPD
Mary Elizabeth Golden, BCBA
- Behavior Analyst
- Woodstock, GA
- NPI 1760333041
NPD (past)
Susan L Jones, SLP
- Speech-Language Pathologist
- Woodstock, GA
- NPI 1518472158
NPD (past)
Lindsay C. McFeeley
- Speech-Language Pathologist
- Woodstock, GA
- NPI 1437639721
NPD (past)

View all 16

NPI Registry JSON

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

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    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739836800000",
    "number": "1730143553",
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        {
            "country_code": "US",
            "country_name": "United States",
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            "city": "MARIETTA",
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            "postal_code": "300627502",
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            "fax_number": "770-783-8639"
        },
        {
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            "telephone_number": "770-977-6866",
            "fax_number": "770-977-6887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOON RIVER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-17",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A",
        "authorized_official_last_name": "DESANTIS",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
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    },
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}

Other providers in Marietta, GA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 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.