Healthcare Provider Details

I. General information

NPI: 1851203665
Provider Name (Legal Business Name): TIFFANY PETERS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15480 THREE OAKS RD
THREE OAKS MI
49128-9545
US

IV. Provider business mailing address

301 E INDIANA AVE
THREE OAKS MI
49128-1305
US

V. Phone/Fax

Practice location:
  • Phone: 931-538-2213
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801122319
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: