Healthcare Provider Details

I. General information

NPI: 1952210007
Provider Name (Legal Business Name): PEACH CITY BEHAVIORAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CORBIN ST
CLANTON AL
35045-2364
US

IV. Provider business mailing address

105 CORBIN ST
CLANTON AL
35045-2364
US

V. Phone/Fax

Practice location:
  • Phone: 205-415-0834
  • Fax:
Mailing address:
  • Phone: 205-415-0834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMERA HINTON
Title or Position: OWNER
Credential:
Phone: 205-415-0834