TIM PETERSON PSY.D.
NPI 1457717613
Psychologist - Clinical in San Antonio, TX

Q: What is Tim Peterson's NPI number?

The NPI number for Tim Peterson is 1457717613. It was assigned to this individual provider in the NPPES registry on January 4, 2016.

Q: What is Tim Peterson's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Tim Peterson was last updated on July 20, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 04, 2016

4940 BROADWAY STE 330, SAN ANTONIO, TX 78209(210) 588-0298 Get Directions Write a Review

NPPES record last updated: July 20, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 20, 2021, Apr 19, 2018, Feb 6, 2017 and 2 more (5 updates tracked since 2016).

On this page

About Tim Peterson Psy.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIM PETERSON PSY.D. (NPI 1457717613) is an individual clinical provider in San Antonio, Texas, licensed in Texas (37292) and active in the NPI registry since January 2016.

NPPES Registry Identity

NPI1457717613

Entity TypeIndividualMale

Primary Taxonomy103TC0700X

Provider Legal NameTIM PETERSONCredential: PSY.D.

Location Address4940 BROADWAY STE 330San Antonio, TX 78209-5744

Mailing Address119 Irvington DrSan Antonio, TX 78209-4217 · (210) 760-3577

Phone(210) 588-0298

Sole ProprietorYes

Enumeration DateJanuary 4, 2016

Last NPPES UpdateJuly 20, 20215 updates tracked since enumeration

NPPES CertifiedJuly 20, 2021

✔ NPI 1457717613 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in TX · 37292

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

4940 BROADWAY STE 330, San Antonio, TX 78209

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tim Peterson's NPI number?

The NPI number for Tim Peterson is 1457717613. It was assigned to this individual provider in the NPPES registry on January 4, 2016.

Where is Tim Peterson located?

Tim Peterson practices at 4940 Broadway Ste 330, San Antonio, TX 78209. The listed phone number is (210) 588-0298.

What is Tim Peterson's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

When was this NPI record last updated?

The NPPES record for Tim Peterson was last updated on July 20, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.