Healthcare Provider Details

I. General information

NPI: 1275763997
Provider Name (Legal Business Name): TIFFNEY PETERS MSW, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 03/25/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WILFORD HALL AMBULATORY SURGICAL CENTER 1100 WILFORD HALL LOOP, BLDG 4554
JBSA-LACKLAND AFB TX
78236-9908
US

IV. Provider business mailing address

446 PIKE RD
SAN ANTONIO TX
78209-3119
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-6016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3657
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: