Provider Demographics
NPI:1619652617
Name:TITUS, BRIAN JAMES (LLPC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JAMES
Last Name:TITUS
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42933 LOMBARDY DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2320
Mailing Address - Country:US
Mailing Address - Phone:734-612-5269
Mailing Address - Fax:
Practice Address - Street 1:3150 PACKARD RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1994
Practice Address - Country:US
Practice Address - Phone:734-203-0183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023054101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty