Healthcare Provider Details

I. General information

NPI: 1619637147
Provider Name (Legal Business Name): I PEEP BXS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2021
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 W PEACHTREE ST NW FL 4
ATLANTA GA
30308-2378
US

IV. Provider business mailing address

PO BOX 19525
ATLANTA GA
30325-0525
US

V. Phone/Fax

Practice location:
  • Phone: 762-622-8360
  • Fax: 888-720-3196
Mailing address:
  • Phone: 762-622-8360
  • Fax: 888-720-3196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DONTA HALLMON
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: BCBA
Phone: 762-622-8360