MEDICARE: TIFFNEY PETERS MSW, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	1041C0700X	Clinical Social Worker	3657	KY

General Provider Information

NPI Number	:	1275763997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFNEY PETERS MSW, PHD

Provider Business Mailing Address
First Line	:	446 PIKE RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	WILFORD HALL AMBULATORY SURGICAL CENTER
Second Line	:	1100 WILFORD HALL LOOP, BLDG 4554
City	:	JBSA-LACKLAND AFB
State	:	TX
Zip	:	78236-9908
Country	:	US
Telephone Number	:	210-292-6016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	03/25/2022

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