Doctor Name: | DEBRA TITUS |
NPI Number: | 1285039222 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MO1000188 |
Business Practice Address: | 306 E Whittier Ave Fairborn, OH - 453245313 |
Business Phone Number: | 9378784616 |
Business Fax Number: | |
Mailing Address: | 306 E Whittier Ave, FAIRBORN |
State: | OH |
Postal Code: | 453245313 |
Phone Number: | 9378784616 |
Fax Number: | |
NPI Enumeration Date: | 11/04/2014 |
NPI Last Update Date: | 11/04/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | MO1000188 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |