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General NPI Number Information
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NPI Number | 1467992164
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Entity Type | Individual
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Provider Name | TIFFANY PETERSON
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Gender | Female
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 5880 STATE HIGHWAY 67
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City | FLORENCE
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State | CO
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Zip | 81226-9791
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Country | US
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Telephone | 719-784-9464
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8500
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City | FLORENCE
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State | CO
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Zip | 81226-8500
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP5008
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 36674
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License Number State | TX
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