TIM PETERSON (NPI# 1457717613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457717613 |
| Entity Type | Individual |
| Full Name | TIM PETERSON |
| Credential | PSY.D. |
| Practice Address |
4940 Broadway St Suite 139 San Antonio TX 78209-5747 |
| Mailing Address |
119 Irvington Dr San Antonio TX 78209-4217 |
| Practice Telephone | 2105880298 |
| Mailing Telephone | 2107603577 |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2018-04-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
37292 | TX | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417398470 | Tim J Peterson | Pharmacist | 200 Hawkins Dr, General Hospital Cc101, Iowa City, IA 52242-1009 | 2013-07-07 |
| 1568618916 | Tim Gerard Peterson | Pathology | 1415 Tulane Ave, New Orleans, LA 70112-2600 | 2008-08-15 |
| 1497932933 | Tim Peterson | Counselor | 403 E Madison St, South Bend, IN 46617-2322 | 2008-01-28 |
| Street Address |
4940 BROADWAY ST SUITE 139 |
| City | SAN ANTONIO |
| State | TX |
| Zip Code | 78209-5747 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124477583 | My Nutrition Studio | Dietitian, Registered | 4940 Broadway St, Ste 118, San Antonio, TX 78209-5747 | 2016-06-07 |
| 1336507516 | Kelley Frost | Counselor | 4940 Broadway St, Suite 302, San Antonio, TX 78209-5747 | 2016-02-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891346359 | Westlake Dermatology of San Antonio Pllc | Dermatology | 5500 Broadway Ave Ste R100, Alamo Heights, TX 78209 | 2019-09-26 |
| 1265086045 | Westlake Dermatology, Pa | Dermatology | 5500 Broadway Ave, Alamo Heights, TX 78209 | 2019-07-30 |
| 1194207530 | Arthur Davies | Licensed Vocational Nurse | 8700 Crownhill Blvd #300, San Antonio, TX 78209 | 2018-09-01 |
| 1538649462 | Jessica Michelle Moore | Licensed Vocational Nurse | 8400 Crown Hill Blvd, San Antonio, TX 78209 | 2018-08-20 |
| 1871072645 | Olawunmi Olapeju Odele | Licensed Vocational Nurse | 8700 Crownhill Blvd. Ste.300, San Antonio, TX 78209 | 2018-08-12 |
| 1265921126 | Ashley L Garcia | Physician Assistant | 414 W Sunset Rd Ste 205, San Antonio, TX 78209 | 2018-05-07 |
| 1083117428 | New Choices Treatment Center LLC | Substance Abuse Rehabilitation Facility | 3050 Eisenhauer Rd Apt 501, San Antonio, TX 78209 | 2018-03-12 |
| 1629570106 | Julieta Rubio Hobbs | Counselor | 4301 Broadway St. 438, San Antonio, TX 78209 | 2018-03-01 |
| 1326550187 | Shannon Lee Crowley | Occupational Therapy Assistant | 403 Irvington Dr, San Antonio, TX 78209 | 2017-11-01 |
| 1932627007 | Juanita De Luna Salazar | Physical Therapist | 1635 Ne Interstate 410 Loop, #600, San Antonio, TX 78209 | 2017-09-08 |
| Find all providers in zip 78209 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194323097 | Ashleigh Elizabeth Fellows | Psychologist | 11750 Mission Trace St, San Antonio, TX 78230-2120 | 2020-10-13 |
| 1063990976 | Diane Laverne Coalson | Psychologist | 16803 Turkey Point St, San Antonio, TX 78232-1828 | 2018-08-02 |
| 1396251757 | Dr. Jacob Pickard Phd, Clinical Psychologist, PC | Psychologist | 1854 Lockhill Selma Rd Ste 102, San Antonio, TX 78213-1557 | 2017-12-21 |
| 1730698903 | Stefanie Anne Gray | Psychologist | 14802 Jones Maltsberger Rd Ste 1201, San Antonio, TX 78247 | 2017-09-20 |
| 1801317334 | Alliance Psychology Specialists, Pllc | Psychologist | 7201 Broadway St Ste 218, San Antonio, TX 78209-3773 | 2017-07-06 |
| 1508317116 | John Martin Velasquez | Psychologist | 4030 Tallulah Dr, San Antonio, TX 78218-3448 | 2016-10-18 |
| 1275980740 | Richard John Rini | Psychologist | 4607 Midnight Woods St, San Antonio, TX 78249-1817 | 2016-05-15 |
| 1821451402 | Trudi Zaplac, J.d., Ph.d., Pllc | Psychologist | 7715 Wexford Sq, San Antonio, TX 78240-3923 | 2016-04-01 |
| 1174981542 | Needhi Bhaga | Psychologist | 531 Stonewood St, San Antonio, TX 78216-7920 | 2016-02-01 |
| 1831555069 | Lindsay M Bira | Psychologist | 503 Avenue A Apt 1420, San Antonio, TX 78215-1277 | 2016-01-04 |
| Find all providers in SAN ANTONIO | ||||
| City | SAN ANTONIO |
| Zip Code | 78209 |
Please comment or provide details below to improve the information on TIM PETERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.