Healthcare Provider Details

I. General information

NPI: 1063924330
Provider Name (Legal Business Name): PEACH TREE ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 AVENUE D STE B
BILLINGS MT
59102-3043
US

IV. Provider business mailing address

2811 ALLISON CT
BOZEMAN MT
59718-6053
US

V. Phone/Fax

Practice location:
  • Phone: 406-624-6599
  • Fax: 888-336-0944
Mailing address:
  • Phone: 406-624-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KRISTI EKSTROM
Title or Position: OWNER
Credential:
Phone: 406-624-6599