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LIFE FULLY LIVED, LLC

Mental Health

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Contact Information

LIFE FULLY LIVED, LLC
19 BRANDYWINE BLVD
TALLEYVILLE, DE  19803-1838
 Phone: 302-703-7779
 Fax:
 Website:
 

Specialty

 Taxonomy Code Specialty Code Provider Type

Mental Health

 101YM0800X
 

Clinical

 1041C0700X 80 Licensed Clinical Social Worker
 

Nurse Practitioner

 363L00000X 50 Nurse Practitioner
 

Psychologist

 103T00000X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for LIFE FULLY LIVED, LLC

NPI # 1003408352
LBN Legal business name LIFE FULLY LIVED, LLC
Authorized official MEGAN DOYLE - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/08/2021
Last updated 12/24/2023 - About 2 years ago
Identifiers
DE Medicaid 1023361136
DE Medicaid 1093300527
DE Medicaid 1124693056
DE Medicaid 1134272610
DE Medicaid 1134488711
DE Medicaid 1275287823
DE Medicaid 1366405433
DE Medicaid 1538734959
DE Medicaid 1891379467
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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