Provider Demographics
NPI:1063483758
Name:TITUS, EARLE CLIFTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:EARLE
Middle Name:CLIFTON
Last Name:TITUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SAINT JOHN RD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7354
Mailing Address - Country:US
Mailing Address - Phone:219-879-4621
Mailing Address - Fax:219-873-2388
Practice Address - Street 1:450 SAINT JOHN RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7354
Practice Address - Country:US
Practice Address - Phone:219-879-4621
Practice Address - Fax:219-873-2388
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040969A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN485380Medicare ID - Type Unspecified