Individual
TIM PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
4940 BROADWAY STE 330, SAN ANTONIO, TX 78209-5744
(210) 588-0298
Mailing address
119 IRVINGTON DR, SAN ANTONIO, TX 78209-4217
(210) 760-3577
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
37292
TX
Other
Enumeration date
01/04/2016
Last updated
07/20/2021
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