Moon River, LLC
Moon River, LLC is a healthcare organization registered as Behavior Analyst in Marietta, GA, holding Type 2 (organization) NPI 1730143553 since 2006. The authorized official on file is Laura Desantis, Office Manager.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1730143553 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Moon River, LLC |
| Practice address | 790 OAK TRAIL DR, Marietta, GA, 30062 |
| Phone | 7709776866 |
| Fax | 7709776887 |
| Enumeration date | 2006-04-17 |
| Last updated in NPPES | 2025-02-18 |
Authorized official
| Name | Laura Desantis |
|---|---|
| Title | Office Manager |
| Phone | 7702122170 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 103T00000X | Psychologist | Secondary | — | — |
| 225100000X | Physical Therapist | Secondary | PT003833 | GA |
| 225XP0200X | Pediatric Occupational Therapist | Secondary | OT 004293 | GA |
| 225XP0200X | Pediatric Occupational Therapist | Secondary | GAOT001717 | GA |
| 235Z00000X | Speech-Language Pathologist | Secondary | SLP003992 | GA |
| 235Z00000X | Speech-Language Pathologist | Secondary | SLP005806 | GA |
| 235Z00000X | Speech-Language Pathologist | Secondary | SLP006528 | GA |
| 235Z00000X | Speech-Language Pathologist | Secondary | SLP 06551 | GA |
| 235Z00000X | Speech-Language Pathologist | Secondary | SLP 006556 | GA |
| 103K00000X | Behavior Analyst | Primary | — | — |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 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 | — |
Copy-ready billing details
Provider: Moon River, LLC NPI: 1730143553 Taxonomy: 103K00000X (Behavior Analyst) Address: 790 OAK TRAIL DR, Marietta, GA, 30062
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1215150925 | Samer Clark | Individual | Physical Therapist | Marietta, GA |
Verify this record
Cross-check NPI 1730143553 against the authoritative CMS record: view Moon River, LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What type of organization is Moon River, LLC?
What is a Type 2 NPI?
Source: CMS NPPES (public data). Snapshot 2026-07-09. Provider record last updated 2025-02-18.